Technique for minimally invasive reduction of calcaneal fractures using small bilateral external fixation

Soft tissue complications are well known after extensile exposure of the calcaneus for open reduction internal fixation of fractures. A variety of recommendations have been proposed to reduce soft tissue healing issues and infection. Despite these recommendations, some surgeons believe that soft tissue complication rates have remained unacceptably high with lateral extensile incisions. Recently, interest in minimally invasive repair techniques for calcaneal fractures has increased. These techniques have been purported to avoid some of the common soft tissue problems seen with calcaneal open reduction internal fixation. The focus of the present communication is to share a minimally invasive surgical method for the reduction and fixation of calcaneal fractures. Percutaneous fixation of the posterior facet fragments can be facilitated by distraction of the fractured calcaneus using skeletal traction and a small bilateral external fixator. Final stability is achieved with a combination of the external fixator and percutaneous screws and/or wires. We present our technique and discuss recent published studies on minimally invasive repair of calcaneal fractures.