Innovative Treatment for Complex Fractures of Calcaneum by Minimally Invasive Surgery

Abstract

Introduction: Complex fractures of calcaneum are one of the most difficult fractures to treat for an orthopaedic surgeon. Per¬sistent pain, oedema and broadening of the heel are common complications postoperatively. The treatment is controversial and none of it is ideal. Results of fixation with the calcaneal plate are not satisfactory and other surgical treatments can’t prevent subtalar collapse. Methods: Comminuted, complex, depressed fracture of the calcaneum is elevated with Steinman pin insertion which is used as a joystick. If necessary, the cortico-cancellous screw is pushed to support the subtalar joint. The vacuum is created by elevation within the shell of the calcaneum which is pierced by the guidewire and then the DHS reamer is passed from posterior to the anterior portion of the calcaneum to shift the cancellous portion of the bone in the desired area. The harvested fibular stud graft is pushed from posterior to the anterior aspect of calcaneum over a guidewire to support the gap. So the fibula acts as a supporting stud as well as the cortical cancellous graft. Results: The criteria for patient-related outcome measures include a reduction in pain, correction of the broadened heel, tiptoes and heel touch standing, painless walking and radiological and clinical healing of the fracture, correction of subtalar depression. Out of twenty-seven patients, we have achieved excellent results in twenty-six patients and good result in one patient. Conclusion: This is our innovative minimally invasive technique for tackling comminuted complex depressed fractures of the calcaneum. Fibular stud graft helps in packing the gap, providing stud support as well as cancellous grafting which is giving excellent results of maintaining the heel contour of a proper size, relieving the pain early and providing a virtually good range of movement.