External fixation for displaced intra-articular calcaneal fractures: A case series

Intra-articular calcaneus fractures (CF) remain challenging. Surgery aims to restore subtalar joint congruence and calcaneus width, height, shape, and alignment, thereby avoiding medial and lateral impingement and enabling patients to resume a normal lifestyle. We retrospectively evaluated 32 patients (35 fractures) with a minimum displacement of 2 mm of the posterior facet and disruption of the calcaneus length, width, and height. Treatment involved a minimally invasive sinus tarsi approach and definitive stabilization with an external fixator (EF). The mean time to partial weight-bearing was 32 days, and the EF was removed at an average of 92 days. At final follow-up (mean 22.2 months), the mean American Orthopaedic Foot and Ankle Society (AOFAS) score was 75.4. Two patients developed superficial pin-tract infections (5.7%), both resolved without further sequelae. No patient experienced deep infection or wound-healing complications. Based on these findings, EF appears to be a valid alternative to open reduction and internal fixation, allowing adequate reduction, early mobilization, and acceptable functional outcomes with minimal complications.