A Modified Design External Fixator System for Calcaneal Fractures: Surgical Technique and an Observational Single-Center Study.

Background

Displaced intra-articular calcaneal fractures are difficult to treat due to their complex anatomy and the high risk of soft-tissue complications. Although open reduction and internal fixation (ORIF) enables accurate anatomical reconstruction, it can be associated with substantial wound morbidity. Minimally invasive techniques have been developed to mitigate these risks. This study aims to describe a modified external fixation technique and report its clinical and radiographic outcomes in consecutive cases of patients with displaced intra-articular calcaneal fractures, with a minimum follow-up period of one year.

Methods

The surgical technique is described in detail. The technique was evaluated by analyzing the treatment results in a case series of 17 patients. The time from injury to surgery, radiographic parameters (Böhler's angle and time to union) and clinical outcomes were recorded and analyzed, as were complication rates. The minimum follow-up period was 12 months.

Results

Surgical reconstruction was performed at a mean of three days (range 1-6 days; SD 1.5) after injury. Preoperative radiographic parameters showed significant deformity, with calcaneal morphology restored at follow-up. At 12 months, the mean Böhler angle had increased to 27.8°, and all fractures had achieved radiographic union. Functional outcomes improved progressively over time, with increases in both the AOFAS and SF-12 P scores. One complication was observed: K-wire displacement requiring conversion to ORIF in a psychiatric patient.

Conclusions

The proposed technique facilitates early surgical treatment and the satisfactory restoration of calcaneal morphology with no soft-tissue complications. It appears to be safe and effective in selected patients. A longer follow-up will provide further insight into long-term outcomes, such as subtalar osteoarthritis.