Clinical Experience of Close Reduction and Internal Fixation of Displaced Intra-articular Fractures of Calcaneum

ABSTRACT

Background: Displaced intra-articular fractures of calcaneum require conventional surgical treatment using open reductionand plate screw fixation which are technically demanding and result in several soft tissue complications and morbidity.Aims and Objectives: An attempt has been made to adopt close reduction and internal fixation without opening the fractureunder fluoroscopic control avoiding the complications of open reduction.Materials and Methods: A total of 30 patients presented with displaced calcaneum fractures of age varied from 19 years to60 years, of which 25 males and 5 females were operated between December 2013 and August 2015. Under spinal anesthesia,in prone position, K-wires were passed through calcaneum and talus for Joshi’s External Stabilisation System (JESS) distraction.Some patients required elevation of subtalar articular fragment by a small window from the lateral side. After restoring thearticular anatomy, three CHSs passed under fluoroscopic control. Then, distracters were removed. Some patients needed anadditional lateral-to-medial screw fixation for holding sustantaculamtali fragment. Conventional post-operative regimen wasfollowed with weight bearing after 3 months.Results: The patients were followed for 8 months to 1.5 yrs. The patients were studied using clinico-radiologicalparameters - wound status, Bohler’s angle, the American Orthopedic Foot and Ankle Society score, and Allmacher grade. Allpatients recovered satisfactory functions in longest follow-up.Conclusion: This method is technically easy, soft tissue friendly with least complications and may be advocated for the provisionof surgical treatment for displaced intra-articular calcaneum fractures.