Primary subtalar arthrodesis is a viable option for selected patients with a calcaneal fracture

The aim of this study was to describe the surgical and functional outcome and quality of life after open reduction and internal fixation (ORIF) combined with subtalar arthrodesis (primary subtalar arthrodesis) for displaced intra-articular calcaneal fractures, using the sinus tarsi surgical approach. We also compared these results with those of an earlier study which we undertook regarding ORIF and delayed subtalar arthrodesis for these fractures. An overall aim was to provide new insights and guidance regarding the indications for the use of primary subtalar arthrodesis in these patients.

This was a retrospective study of 62 patients with 64 displaced intra-articular fractures of the calcaneum, who underwent primary subtalar arthrodesis between August 2012 and January 2024. Surgical outcomes and patient-reported outcome measures (PROMs), including the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score, Foot Function Index (FFI) score, and EuroQoL five-dimension questionnaire (EQ-5D) index/visual analogue scale (VAS) score, were recorded at many timepoints. Finally, potential predictors of outcome were analyzed.

The median follow-up of the surveys was 2.5 years (IQR 1.6 to 6.2). The median Böhler angle postoperatively was 29.5° (IQR 25.0° to 32.8°). Subtalar union was achieved in 59 cases (92.2%) with four successful revision arthrodeses. One patient died of unrelated causes. There was deep surgical site infection in four (6.3%), and screws were required to be removed in ten (15.6%). The median AOFAS and FFI scores were 80.0 (IQR 59.0 to 90.0) and 18.0 (IQR 5.3 to 39.5). The median EQ-5D index score was 0.843 (IQR 0.762 to 0.904) and the median EQ-5D VAS score was 81.0 (IQR 70.0 to 90.0).

ORIF combined with subtalar arthrodesis provided good rates of subtalar union and good functional outcomes. These results were similar or better than those following ORIF alone or delayed arthrodesis. These findings support the use of this procedure in selected patients, using predefined criteria, potentially reducing the need for secondary surgery and improving the overall outcome.