Primary subtalar arthrodesis in displaced intra-articular calcaneal fracture: a systematic review

Calcaneus fractures are severe injuries often resulting from traumatic falls or motor vehicle accidents. Surgical treatment through open reduction and internal fixation (ORIF) is considered the standard approach for displaced intra-articular calcaneal fractures (DIACFs), but it is associated with many complications. Our study aimed to review the current literature available on primary subtalar arthrodesis (PSA) as a first-line treatment for DIACFs, mostly Sanders type IV. In this study, we conducted a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The keywords were searched in PubMed, MEDLINE and the Cochrane Library. This review included articles where primary arthrodesis was performed in calcaneal fractures, with or without associated implants. Nine articles were included in the review. The total population comprised 184 patients with 192 calcaneal fractures. The mean age was 44.9 ± 6.9 years old. The mean follow-up period was 30.28 ± 15.29 months when reported. The mean time to surgery was 13.33 ± 7.02 days from injury. All studies reported a good fusion rate (between 94 and 100%) and an average fusion time of 4.05 ± 2.19 months. The mean American Orthopedic Foot & Ankle Society (AOFAS) score was 71.26 ± 8, and the mean Visual Analog Scale (VAS) score for pain was 3.26 ± 0.91. Primary arthrodesis of the subtalar joint for treating DIACFs, mostly Sanders type IV, provides good results due to the avoidance of further procedures, reduced postoperative pain, and a high rate of bony union. However, success heavily depends on factors such as patient comorbidities and addressing hindfoot deformity. Further studies with larger patient populations and more standardized protocols are necessary to draw definitive conclusions about the best management strategies for DIACFs. Systematic review, level III of evidence.