Percutaneous, arthroscopically-assisted osteosynthesis of calcaneus fractures

Background: The development of major and minor wound complications is a major concern in the open reduction and internal fixation of displaced intra-articular calcaneus fractures. Percutaneous, arthroscopically assisted screw osteosynthesis was developed to minimize the surgical approach without risking inadequate reduction of the subtalar joint. The method was applied in selected cases of displaced intra-articular calcaneus fractures with one fracture line crossing the posterior calcaneal facet (Sanders type 11 fractures). Methods: Between March 1998 and July 2000, 15 patients were treated with that method. Percutaneous leverage was carried out with a Schanz screw introduced into the tuberosity fragment (the Westhues maneuver) under direct arthroscopic and fluoroscopic control. After anatomic reduction was achieved, the fragments were fixed with three to six cancellous screws introduced via stab incisions. Results: The functional results of 10 patients at a minimum of I year follow-up are good to excellent, with an average AOFAS ankle-hindfoot score of 93.7 (range 87-100) and an average Maryland Foot Score of 95.8 (range 93-100). Overall patient comfort and satisfaction were superior to open reduction for similar fracture patterns, and the in-hospital time could be reduced. Conclusions: Percutaneous, arthroscopically assisted osteosynthesis offers exact assessment of the articular surface and allows anatomical reduction while adhering to the principles of minimally invasive surgery. The short-term results are excellent, while long-term results with greater patient cohorts are awaited.