Reconstructive osteotomy of the calcaneus with subtalar arthrodesis for malunited calcaneal fractures.

A technique of dealing with the late complications of malunited calcaneal fractures is based on the philosophy of reversing the deformity associated with late complications. The primary fracture is a shearing fracture that runs obliquely down the length of the calcaneus from superolateral to inferomedial and anterolateral to posteromedial. This permits the tuberosity of the calcaneus to translate laterally and proximally, and often splits the posterior facet. The complications of malunion are loss of height of the heel with concomitant dorsiflexion of the talus, widening of the heel, lateral impingement of the peroneal tendons and the distal fibula, and subtalar posttraumatic arthritis. The primary fracture deformity contributes directly to the late complications. The reconstructive osteotomy recreates the primary fracture. This permits repositioning of the tuberosity that narrows the heel, alleviates impingement, and returns height to the heel. The subtalar arthrodesis alleviates the symptoms of posttraumatic arthritis. The reconstruction is not dependent on cortical bone grafts for stability. The clinical series involved ten feet with an average follow-up period of 14 months. Two were revisions of previous triple arthrodeses. Results were satisfactory in nine feet.