SLR - February 2012 - Ryan Ohlgart
Reference: Young KW, Lee KT, Lee YK, Jang MS, Yoon JH, and Kim JH, Orthopedics 34(10), 634-8, 2011.
Scientific Literature Review
Reviewed by: Ryan Ohlgart, DPM
Residency Program: Detroit Medical Center
Podiatric Relevance:
Calcaneal fractures are devastating injuries that often lead to continued pain and impairment, even following corrective surgery. Surgical reduction does not guarantee that malunion will not occur. This study aimed to determine whether pain and other symptoms can be treated successfully with calcaneal osteotomies and restoration of calcaneal height, instead of the more traditional subtalar joint arthrodesis in patients with calcaneal malunion without severe subtalar joint arthritis.
Methods:
Over a three year period, patients with a mean age of 43.1 years and had the inclusion criteria of a diagnosis of malunion of calcaneal fracture, prior surgery for calcaneal fracture, and postoperative pain were treated with calcaneal reconstruction. Twenty-one patients (twenty-two feet) were able to be followed for greater than a two year postoperative period. Surgical reconstruction included sliding or wedge calcaneal osteotomy, exostectomy, and decompression of the lateral calcaneal wall.
Results:
Radiographic review showed a mean Böhler angle was increased from 24.1° preoperatively to 35.4° postoperatively, calcaneal pitch improved from 12.0° to 16.8° postoperatively, and talocalcaneal angle increased from 15.5° to 19.6° postoperatively. Stephen and Sanders types I, II, and II calcaneal malunions were observed in 3, 15, and 4 patients preoperatively. This was improved to 9, 13, and 0 postoperatively. Mean AOFAS scores improved from 63.9 preoperatively to 78.7 postoperatively. Three patients had to undergo further surgery including a subtalar arthrodesis for continued pain.
Conclusions:
Calcaneal reconstruction following malunion of a calcaneal fracture with failed surgical reduction is a viable option for patients that may not wish to undergo subtalar arthrodesis primarily. In this series, 86 percent were very satisfied or satisfied with the outcome of their procedure. The need for future subtalar joint arthrodesis cannot be ruled out, but calcaneal reconstruction may be viewed as a viable option for select patients.