Mid-term follow up results of Calcaneal Reconstruction for the Late Complication of Calcaneus Fracture

Category: Trauma Introduction/Purpose: Calcaneal fracture is the most common fracture in hindfoot. The treatment is challenging, because of various patterns of fractures and high complication rates which leads to high level of dysfunction and low satisfaction of the patients. There are many previous studies reporting various methods about treatment of calcaneal malunion, such as subtalar arthrodesis, corrective osteotomy and corrective osteotomy with subtalar arthrodesis. However, there are no mid-term clinical results reporting about lateral ostectomy and sliding osteotomy, which is called calcaneal reconstruction. The purpose of this study is to evaluate the mid-term clinical and radiologic results of calcaneal reconstruction in the patients who have chronic complications after calcaneal fracture. Methods: Between January 2009 to May 2014, 196 patients (257 feet) were treated by calcaneal fracture. 34 patients (37 feet) underwent calcaneal reconstruction because of the dysfunction and the pain caused by malunion. Inclusion criteria were those whom underwent calcaneal reconstruction and able to be followed up at least 4 years postoperatively. The patients who had severe subtalar arthritis or whom underwent subtalar arthrodesis or simple bone resection were excluded. We reviewed 10 patients (10 feet) postoperatively and at mid-term follow up. Radiologic results including Böhler angle, calcaneal pitch, talocalcaneal height, talar inclination, talocalcaneal angle, talo-1st metatarsal angle, calcaneal width were measured and clinical results including AOFAS Ankle-Hindfoot scale and VAS score were checked preoperative, postoperatively and at the last follow up. The satisfaction of the patient was checked by survey. Results: The mean interval between the first operation and reconstructive operation was 16.6 months. The mean follow-up period after calcaneal reconstruction was 67.1 months. The most common symptom of the patient were pain on the inferior aspect of the lateral malleolus (4 patients) and heel area (3 patients). After calcaneal reconstruction, all the mean values of talocalcaneal height, calcaneal pitch, and Böhler angle were improved, which was statistically significant, respectively. In the postoperative period, 3 patients were very satisfied, 5 were satisfied, and 2 were not satisfied. The results maintained till mid-term follow up. Also, AOFAS and VAS score were improved comparing pre-reconstruction and mid-term follow up. Although the pain did not completely resolved, most of the patients were satisfied postoperatively. Conclusion: In patients without severe subtalar arthritis, the known main causes of the pain in calcaneal malunion are the loss of calcaneal height and hindfoot widening rather than subtalar arthritis. Our results showed signigficant clinical and radiological results by calcaneal reconstruction. And the outcome maintained till mid-term follow up. Calcaneal reconstruction can be a good choice for chronic pain which is caused by malunion of calcaneal fracture without severe subtalar arthritis.