Joint-preserving osteotomy for malunited intra-articular calcaneal fractures

Displaced intra-articular fractures of the calcaneus can lead to severe pain and disability if not treated appropriately. Failure to treat may require fusion of the subtalar joint, supplemented by additional osteotomies. Occasionally, these fractures are seen after the fracture has just healed, and the decision to treat can be a difficult one. Over the course of 10 years, 5 patients were treated with a corrective osteotomy along the primary fracture line, joint realignment, soft tissue balancing, and secondary internal fixation at a mean of 2.9 months after the injury. At a mean of 4.1 years (range, 2-10 years), all patients were satisfied with their result. Two patients underwent implant removal and subtalar arthrolysis 1 year after correction. No secondary fusions were required. The mean American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score improved significantly from 19.0 preoperatively to 81.2 at follow-up (P < 0.001). The radiographic parameters (the Böhler angle, talocalcaneal height, and heel width) were substantially corrected. A joint-preserving osteotomy with axial realignment can be a treatment option for malunited intra-articular calcaneal fractures encountered early on, before the development of subtalar arthrosis.