A Protocol for Percutaneous Transarticular Fixation of Sanders Type II and III Calcaneal Fractures With or Without an Added Mini-Open Approach

Intra-articular fracture of the calcaneus is one of the most displeasing fractures if not properly managed. Open reduction and internal fixation have been associated with a high incidence of postoperative soft tissue complications. Closed reduction and percutaneous fixation have resulted in a greater incidence of postoperative subtalar osteoarthritis with improper reduction of the articular surface. In the present study, a mini-open approach was used in cases of failure of articular surface restoration with closed reduction. A total of 64 feet in 57 consecutive patients with an intra-articular calcaneal fracture underwent the proposed minimally invasive surgical protocol. Of the 57 patients, 7 (12.3%) had bilateral fractures. According to Sanders classification, 33 (51.6%) fractures were type II and 31 (48.4%) were type III. Seven (12.3%) patients had wedge fractures of the dorsolumbar spine without neurologic manifestations. The postoperative evaluation included radiographs and completion of the Maryland Foot Score and visual analog scale for pain. The mean follow-up period was 16 (range 12 to 36) months. The mean operative time was 42 (range 35 to 60) minutes. The mean period until union of the fracture was 12 (range 10 to 16) weeks. The clinical results according to the Maryland Foot Score revealed 52 (81%) with satisfactory (27 excellent and 25 good) and 12 (19%) with unsatisfactory (10 fair and 2 poor) results. The mean visual analog scale score was 1.5 ± 0.3 when radiographic fracture healing was observed. Six patients (9.4%) developed superficial pin tract infections that responded to local care and parenteral antibiotic therapy and resolved completely after removal of the Kirschner wires. In conclusion, the presented surgical protocol combining closed reduction with or without an added mini-open approach and percutaneous fixation improves the functional outcome and minimizes the incidence of complications.