Minimally-invasive treatment of calcaneal fractures.

Percutaneous reduction methods play an important role in the management of calcaneal fractures with severe soft tissue compromise, particularly open fractures, and they offer a treatment alternative in patients with local or systemic contraindication to open reduction. Percutaneous reduction by pin leverage (Westhues or Essex-Lopresti maneuver) followed by minimally invasive screw fixation is a treatment option that yields good to excellent results in tongue-type fractures with posterior facet displacement as a whole (Sanders-type IIC). This method can be applied to selected Sanders-type IIA or IIB fractures if the quality of joint reduction is controlled arthroscopically. Although some authors have expanded the use of percutaneous reduction by traction, leverage, and compression with subsequent K-wire or screw fixation with remarkable results, the uniform application of percutaneous methods to all intra-articular calcaneus fractures is critical. Inadequate joint reduction and redislocation of the fragments in highly unstable fractures may occur in a considerable percentage of cases. Prolonged transfixation of the subtalar and calcaneocuboid joints is strongly discouraged, because functional aftertreatment is an important part of the rehabilitation after calcaneal fractures.