J Korean Foot Ankle Soc.  2017 Dec;21(4):144-150. 10.14193/jkfas.2017.21.4.144.

Outcomes of Arthroscopic Assisted Reduction and Percutaneous Fixation for Tongue-Type Sanders Type II Calcaneal Fractures

• Park JW
• Park CH

• KMID: 2398012
• DOI: http://doi.org/10.14193/jkfas.2017.21.4.144

Abstract

PURPOSE
To assess the clinical and radiographic results and complications of arthroscopy-assisted reduction and percutaneous fixation for patients with tongue-type Sanders type II calcaneal fractures.
MATERIALS AND METHODS
Between August 2014 and December 2015, 10 patients who underwent surgery using subtalar arthroscopic assisted reduction and percutaneous fixation for tongue-type Sanders type II calcaneal fractures were reviewed. The mean age was 50.8 years (36~62 years), and the mean follow-up period was 24 months (12~40 months). The clinical results were evaluated using the visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score at the regular follow-ups, and the foot function index (FFI) at the last follow-up. The subtalar range of motion (ROM) was evaluated and compared with the uninjured limb at the last follow-up. The radiographic results were assessed using the Böhler's angle from the plain radiographs and the reduction of the posterior calcaneal facet using computed tomography (CT). The postoperative complications were assessed by a chart review.
RESULTS
The VAS and AOFAS ankle-hindfoot score improved until 12 months after surgery. The FFI was 15 (1.8~25.9) and subtalar ROM was 75.5% (60%~100%) compared to the uninjured limb at the last follow-up. The Böhler's angle was increased significantly from 2° (−14°~18°) preoperatively to 21.8° (20°~28°) at the last follow-up. The reduction of the posterior facet was graded as excellent in five feet (50.0%) and good in five (50.0%) on CT obtained at 12 months after surgery. One foot (10.0%) had subfibular pain due to a prominent screw head. One foot (10.0%) had pain due to a longitudinal tear of the peroneal tendon that occurred during screw insertion.
CONCLUSION
Subtalar arthroscopic-assisted reduction of the posterior calcaneal facet of the subtalar joint and percutaneous fixation is a useful surgical method for tongue-type Sanders type II calcaneal fractures.

Keyword

Calcaneal fracture; Subtalar arthroscopy; Percutaneous fixation

MeSH Terms

Ankle
Extremities
Follow-Up Studies
Foot
Head
Humans
Methods
Postoperative Complications
Range of Motion, Articular
Subtalar Joint
Tears
Tendons

Figure

• 

  Figure 1. (A) Three subtalar arthroscopic portals (anterolateral, centrolateral, and posterolateral). The anterolateral portal is made 1 cm distal and 2 cm anterior to the tip of the lateral malleolus. The centrolateral portal is made just anterior to the tip of the lateral malleolus. (B) Fracture site of the calcaneus is visualized through anterolateral portal after debridement of hematoma using shaver. (C) Steinmann pin of 2.4 mm is inserted at the tongue-type fragment for the leverage technique. (D) Reduction of the posterior facet is achieved using leverage technique. (E) Medial and lateral fragments of calcaneus are fixated using two 3.5 mm cortical screws. (F) Anterior and posterior fragments are fixated using two or three 7.0 mm cannulated screws.

• 

  Figure 2. Subtalar range of motion are assessed by measuring the angle between Achilles tendon and calcaneus in full inversion position.

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