Wrist external fixator-assisted percutaneous reduction for intra-articular calcaneal fractures: clinical and radiographic outcomes

BACKGROUND: Percutaneous reduction is a minimally invasive procedure for treating intra-articular calcaneal fractures that helps preserve the integrity of the soft tissues around the subtalar joint and reduces surgical complications. Auxiliary traction and temporary fixation are critical components in the process of percutaneous reduction. To overcome the limitations of current techniques for the percutaneous reduction of intra-articular calcaneal fractures, we introduced a technique in which wrist external fixators are used for assistance. This study aims to assess the effectiveness and safety of this approach through a retrospective case series. METHODS: From March 2015 to September 2018, patients with intra-articular calcaneal fractures who met the inclusion criteria underwent wrist external fixator-assisted percutaneous reduction at our hospital. Postoperatively, X-rays and CT scans were used to evaluate the degree of fracture reduction. The American Orthopedic Foot & Ankle Society (AOFAS) Ankle–Hindfoot score, along with the range of motion of the ankle and subtalar joints, was measured at the final follow-up. RESULTS: Among the 31 patients who completed the follow-up, 10 had Sanders type II fractures, and 21 had Sanders type III fractures. Postoperative imaging revealed significant improvements in calcaneal alignment, including the Böhler and Gissane angles. Excellent or good restoration of the subtalar joint surface was achieved in 83.8% of the patients, as confirmed by postoperative CT scans. The average AOFAS Ankle–Hindfoot score at the final follow-up was 93.84 ± 7.92. The mean range of motion for ankle flexion–extension was 64.35 ± 1.38 degrees, and for the internal–external motion of the subtalar joint, it was 29.27 ± 1.63 degrees, with no significant differences compared with the unaffected side. Only two patients developed subtalar osteoarthritis, and no cases of wound infection, skin necrosis, or sural nerve complications were reported. CONCLUSION: The use of a wrist external fixator to assist in the percutaneous reduction of intra-articular calcaneal fractures appears to be an effective technique for restoring the calcaneal structure. This approach enhances postoperative subtalar joint mobility and overall ankle‒hindfoot function while significantly reducing surgery-related complications.