OPEN REDUCTION AND CIRCULAR EXTERNAL FIXATION OF INTRAARTICULAR CALCANEAL FRACTURES

Open reduction and internal fixation techniques do not allow early wei ght bearing. In an effort to develop a better method to obtain calcane al fracture reduction and maintain it in the face of early weight bear ing, a circular external fixator was applied to seven patients in comb ination with a limited lateral approach and open reduction and interna l fixation of the depressed subtalar joint fragments. The operative te chnique uses the Ilizarov circular external fixator to obtain a ligame ntotaxis reduction, following which the depressed subtalar joint fragm ents are elevated open; then, the fixator is used to reduce the latera l translation. All displacements of the fracture fragments are correct ed. This method proved successful in six patients, all of whom achieve d a satisfactory result with anatomic restoration of the subtalar join t and heel. One patient went on to late partial collapse of the poster ior facet. Subtalar motion was greater than 50% in four of seven patie nts. None of the patients complained of heel pad pain, which was attri buted to the desensitization of the heel by early weight bearing. This technique has produced encouraging preliminary results in two- to fou r-year follow-up evaluation.