J Korean Foot Ankle Soc.  2015 Sep;19(3):122-127. 10.14193/jkfas.2015.19.3.122.

Treatment of Calcaneal Fracture Malunion Using Lateral Exostectomy and Corrective Osteotomy: A Report of Three Cases

Affiliations
  • 1Department of Orthopedic Surgery, Sanbon Hospital, Wonkwang University School of Medicine, Gunpo, Korea. castkim@daum.net

Abstract

Inappropriate treatment for calcaneus fracture may result in malunion causing long-lasting pain and functional deficits. When such complications occur, the ideal principle of management is preserving congruence and motion of adjacent joints. For three patients with calcaneus fracture malunion, subtalar joint-preserving surgery using exostectomy and corrective osteotomy was performed, and satisfactory outcomes were achieved postoperatively.

Keyword

Calcaneus; Malunion; Subtalar joint; Exostectomy; Corrective osteotomy

MeSH Terms

Calcaneus
Humans
Joints
Osteotomy*
Subtalar Joint

Figure

  • Figure 1. Preoperative standing lateral radiograph of affected side (A) shows decreased talocalcaneal height, talar declination angle, talocalcaneal angle, and calcaneal pitch. Sagittal (B) and coronal (C) images of preoperative computed tomography show compressed posterior subtalar facet, widened heel with lateral exostosis, and incongruity of subtalar joint.

  • Figure 2. Lateral wall exostectomy and corrective osteotomy were performed as subtalar joint-preserving surgery. (A) Lateral wall exostectomy was performed with an osteotome and the excised bone fragment was saved. (B) We inspected the subtalar joint and separated the depressed posterior articular facet fragment along the primary fracture line. (C) And debridement of the excised posterior facet was done. (D) With laminar spreader, calcaneus body was distracted to reestablish the height following stepped corrective osteotomy (arrow). (E) Bone graft was done with excised lateral wall fragment. (F) Then, malunited posterior facet fragment was reduced and fixed internally.

  • Figure 3. (A) Standing lateral view at 2 years and 7 months after surgery shows improvement of radiographic measurements such as talocalcaneal height, talar declination angle, talocalcaneal angle, and calcaneal pitch. (B) Calcaneus axial view shows decreased calcaneus width.

  • Figure 4. Single heel rise test was possible with powerful muscular strength of triceps surae.


Reference

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