Management of displaced intraarticular calcaneal fractures by using external ring fixation, minimally invasive open reduction, and early weightbearing.

Twenty-three patients with 25 intraarticular fractures of the calcaneus were treated during a 7-year period with minimally invasive open reduction of the posterior facet, external ring fixation, and early weightbearing. Skeletal traction and a minimally invasive lateral approach were used to elevate the posterior facet. Percutaneous wires, which were secured to an external ring fixator, were used to stabilize the reduction. The patients were encouraged to bear weight on the first postoperative day and during the time the fixator was in place. A retrospective chart review was performed and the Maryland Foot Score was used. The patients ranged in age from 22 to 68 years (average, 43.8 years). Using the Sanders computed tomography classification, there were 17 (68%) type II, 6 (24%) type III, and 2 (8%) type IV fracture patterns. Thirty-two percent of the patients were rated excellent, 60% rated good, and 8% rated fair. Subtalar joint motion was >50% of the uninjured foot in 21 of 25 fractures. Eight of 23 patients (35%) experienced diffuse pain in the rear foot, whereas 4 (17%) complained of localized pain in the plantar heel. Few complications were observed, with the most common being superficial skin infection at a wire insertion site. No deep infections developed. The average length of the treatment period with the fixator was 6.6 weeks (range, 5 to 9 weeks). The range of follow-up was 2 to 7 years. The results with this technique indicate that it is a viable alternative to traditional methods of open reduction and internal fixation for the management of intraarticular fractures of the calcaneus.