Minimally invasive stabilization of calcaneal fractures

Abstract

Fractures of the calcaneus are severe injuries causing far-reaching alterations of hind foot alignment and subtalar joint function. Percutaneous reduction techniques have been successfully used since the first description by Westhues (1934) in the treatment of simple fractures with large tubercular fragments (Sanders IIC). For comminuted intra-articular fractures with separated subtalar fragments, open reduction and internal fixation with locking plate osteosynthesis via the extended lateral approach (ELA) has become established as the gold standard since the 1990s despite a high rate of wound complications of up to 25%. Studies confirmed the association of anatomical joint surface reduction and good outcome and there seems to be no alternative to an open fracture reduction. Meanwhile, modern 3D-imaging technology enables detailed intraoperative analysis of the joint reduction without the need for extensive fracture exposure. By the combination of open joint surface reduction using the minimally invasive sinus tarsi approach with percutaneous reduction and fixation techniques in combination with intraoperative 3D-imaging, a safe treatment even of complex fractures (Sander IIA/B, III) is possible. Therefore, the standardized open reduction which has been carried out for decades could be increasingly replaced by minimally invasive stabilization of calcaneal fractures assisted by modern techniques of intraoperative imaging.