Push screw for indirect reduction of severe joint depression-type calcaneal fractures

Severe joint depression-type calcaneal fractures cause dramatic distortion of hindfoot anatomy, including gross shortening of the heel and lateral translation of the tuberosity. This displacement may alter the mechanics of the foot, interfere with tendon function, or put the medial soft tissues under tension. The displacement is typically corrected by open reduction. However, surgical intervention may be delayed because of soft tissue involvement, higher priority musculoskeletal injuries, or the presence of life-threatening injury. When treatment has been delayed, it may be difficult to restore the height and length of the calcaneus. Application of an external fixator is one option to allow for early indirect fracture reduction of the hindfoot and initial soft tissue healing. However, a percutaneous screw reduction technique reduces the risk of pin tract infection with the external fixateur and allows the soft tissue to regenerate. Bony reduction is gained with the help of a push screw, which allows controlled and gradual reconstitution of the length and height (Böhler's angle) of the hindfoot. This technique, though, is only recommended as a temporary salvage procedure in situations in which a delayed primary subtalar fusion is the only treatment of choice in a severely comminuted high-energy calcaneal fracture.