Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 9 , ISSUE 2 ( April-June, 2022 ) > List of Articles

Review Paper

Late Treatment of Displaced Intra-articular Calcaneus Fractures: When is Late too Late?

Michael Swords, John Shank

Keywords : Calcaneus, Calcaneus fracture, Osteotomies, Subtalar joint, Subtalar arthrodesis, Surgical timing

Citation Information : Swords M, Shank J. Late Treatment of Displaced Intra-articular Calcaneus Fractures: When is Late too Late?. J Foot Ankle Surg Asia-Pacific 2022; 9 (2):67-71.

DOI: 10.5005/jp-journals-10040-1226

License: CC BY-NC 4.0

Published Online: 01-04-2022

Copyright Statement:  Copyright © 2022; The Author(s).


Multiple studies support open reduction and internal fixation of displaced intra-articular calcaneus fractures (DIACFs). Clinical evidence does not currently support a clear, well-defined treatment recommendation for DIACFs that present in a late fashion. The treatment options for this challenging clinical presentation are reviewed as well as current literature on this most difficult clinical scenario. Specific treatment should be catered to the individual patient with consideration of the technical ability of the surgeon.

  1. Essex-Lopresti P. The mechanism, reduction technique, and results in fractures of the os calcis. Br J Surg 1952;39(157):395–419. DOI: 10.1002/bjs.18003915704
  2. Swords MP, Penny P. Early fixation of calcaneus fractures. Foot Ankle Clin 2017;22(1):93–104. DOI: 10.1016/j.fcl.2016.09.006
  3. Spierings KE, Min M, Nooijen LE, et al. Managing the open calcaneal fracture: a systematic review. Foot Ankle Surg 2019;25(6):707–713. DOI: 10.1016/j.fas.2018.10.005
  4. Giordano V, Godoy-Santos AL, de Souza FS, et al. Combined lag screw and cerclage wire fixation for calcaneal tuberosity avulsion fractures. Case Rep Orthop 2018;2018:6207024. DOI: 10.1155/2018/6207024
  5. Griffin D, Parsons N, Shaw E, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ 2014;349:g4483. DOI: 10.1136/bmj.g4483
  6. Poeze M, Verbruggen JPAM, Brink PRG. The relationship between the outcome of operatively treated calcaneal fractures and institutional fracture load. A systematic review of the literature. J Bone Joint Surg Am 2008;90(5):1013–1021. DOI: 10.2106/jbjs.g.00604
  7. Stewart CC, Brodke DJ, Morshed S. Effect of surgeon and hospital volume on complications after operative tarsal fracture repair. J Orthop Trauma 2019;33(11):e416–e421. DOI: 10.1097/BOT.0000000000001586
  8. Al-Mudhaffar M, Prasad CV, Mofidi A. Wound complications following operative fixation of calcaneal fractures. Injury 2000;31(6):461–464. DOI: 10.1016/s0020-1383(00)00026-7
  9. Rammelt S, Barthel S, Biewener A, et al. [Calcaneus fractures. Open reduction and internal fixation]. Zentralbl Chir 2003;128(6):517–528. DOI: 10.1055/s-2003-40627
  10. Tennent TD, Calder PR, Salisbury RD, et al. The operative management of displaced intra-articular fractures of the calcaneum: a two-centre study using a defined protocol. Injury 2001;32(6):491–496. DOI: 10.1016/s0020-1383(01)00024-9
  11. Buckley R, Tough S, McCormack R, et al. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am 2002;84(10):1733–1744. DOI: 10.2106/00004623-200210000-00001
  12. Agren P-H, Mukka S, Tullberg T, et al. Factors affecting long-term treatment results of displaced intraarticular calcaneal fractures: a post hoc analysis of a prospective, randomized, controlled multicenter trial. J Orthop Trauma 2014;28(10):564–568. DOI: 10.1097/BOT.0000000000000149
  13. Agren P-H, Wretenberg P, Sayed-Noor AS. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am 2013;95(15):1351–1357. DOI: 10.2106/JBJS.L.00759
  14. Sanders R, Vaupel ZM, Erdogan M, et al. Operative treatment of displaced intraarticular calcaneal fractures: long–term (10–20 Years) results in 108 fractures using a prognostic CT classification. J Orthop Trauma 2014;28(10):551–563. DOI: 10.1097/BOT.0000000000000169
  15. Rammelt S, Amlang M, Barthel S, et al. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res 2010;468(4):983–990. DOI: 10.1007/s11999-009-0964-x
  16. Rammelt S, Amlang M, Sands AK, et al. [New techniques in the operative treatment of calcaneal fractures]. Unfallchirurg 2016;119(3): 225–236;quiz 236–238. DOI: 10.1007/s00113-016-0150-z
  17. Mehta CR, An VVG, Phan K, et al. Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis. J Orthop Surg Res 2018;13(1):243. DOI: 10.1186/s13018-018-0943-6
  18. Khazen G, Rassi CK. Sinus tarsi approach for calcaneal fractures: the new gold standard?. Foot Ankle Clin 2020;25(4):667–681. DOI: 10.1016/j.fcl.2020.08.003
  19. Wallace B, Chhabra A, Narayanan A, et al. Low risk of wound complications with sinus tarsi approach for treatment of calcaneus fractures. J Foot Ankle Surg 2021;S1067–2516(21)00477–00484. DOI: 10.1053/j.jfas.2021.11.013
  20. Schepers T, Backes M, Dingemans SA, et al. Similar anatomical reduction and lower complication rates with the sinus tarsi approach compared with the extended lateral approach in displaced intra-articular calcaneal fractures. J Orthop Trauma 2017;31(6):293–298. DOI: 10.1097/BOT.0000000000000819
  21. Swords M, Shank J, Fraticelli N, et al. Late treatment of displaced intra-articular calcaneus fractures: successful management with anatomic reduction. J Orthop Trauma 2020;34(Suppl 1):S21–S25. DOI: 10.1097/BOT.0000000000001694
  22. Rammelt S, Grass R, Zwipp H. Joint-preserving osteotomy for malunited intra-articular calcaneal fractures. J Orthop Trauma 2013;27(10):e234–238. DOI: 10.1097/BOT.0b013e318290ff07
  23. Rammelt S, Schneiders W, Zwipp H. [Joint-preserving osteotomy for calcanean malunions]. Unfallchirurg 2014;117(9):776–784. DOI: 10.1007/s00113-014-2602-7
  24. Yu G-R, Hu S-J, Yang Y-F, et al. Reconstruction of calcaneal fracture malunion with osteotomy and subtalar joint salvage: technique and outcomes. Foot Ankle Int 2013;34(5):726–733. DOI: 10.1177/1071100713479766
  25. Buch BD, Myerson MS, Miller SD. Primary subtaler arthrodesis for the treatment of comminuted calcaneal fractures. Foot Ankle Int 1996;17(2):61–70. DOI: 10.1177/107110079601700202
  26. Huefner T, Thermann H, Geerling J, et al. Primary subtalar arthrodesis of calcaneal fractures. Foot Ankle Int 2001;22(1):9–14. DOI: 10.1177/107110070102200102
  27. Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res 1993;(290):87–95. DOI: 10.1097/00003086-199305000-00012
  28. Rammelt S, Zwipp H. Corrective arthrodeses and osteotomies for post-traumatic hindfoot malalignment: indications, techniques, results. Int Orthop 2013;37(9):1707–1717. DOI: 10.1007/s00264-013-2021-3
  29. Radnay CS, Clare MP, Sanders RW. Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter? Surgical technique. J Bone Joint Surg Am 2010;92(Suppl 1):32–43. DOI: 10.2106/JBJS.I.01267
  30. Carr JB, Hansen ST, Benirschke SK. Subtalar distraction bone block fusion for late complications of os calcis fractures. Foot Ankle 1988;9(2):81–86. DOI: 10.1177/107110078800900204
  31. Romash MM. Reconstructive osteotomy of the calcaneus with subtalar arthrodesis for malunited calcaneal fractures. Clin Orthop Relat Res 1993;(290):157–167. DOI: 10.1097/00003086-199305000-00020
  32. Rammelt S, Grass R, Zawadski T, et al. Foot function after subtalar distraction bone-block arthrodesis. J. Bone Surg 2004;86-B(5): 659–668. DOI: 10.1302/0301-620X.86B5.14205
  33. Stephens HM, Sanders R. Calcaneal malunions: results of a prognostic computed tomography classification system. Foot Ankle Int 1996;17(7):395–401. DOI: 10.1177/107110079601700707
  34. Clare MP, Lee WE, Sanders RW. Intermediate to long-term results of a treatment protocol for calcaneal fracture malunions. J Bone Joint Surg Am 2005;87(5):963–973. DOI: 10.2106/jbjs.c.01603
  35. Flemister AS, Infante AF, Sanders RW, et al. Subtalar arthrodesis for complications of intra-articular calcaneal fractures. Foot Ankle Int 2000;21(5):392–399. DOI: 10.1177/107110070002100506
  36. Rammelt S, Zwipp H. Arthrodesis with realignment. In Coetzee JC, Hurwitz SR, editors: Arthritis and Arthroplasty: the foot and ankle, Philadelphia, 2009, Saunders Elsevier, pp 238–248.
  37. Dürr C, Apinun J, Mittlmeier T, et al. Foot function after surgically treated intraarticular calcaneal fractures: correlation of clinical and pedobarographic results of 65 patients followed for 8 years. J Orthop Trauma 2018;32(12):593–600. DOI: 10.1097/BOT.0000000000001325
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