An introduction to the minimally invasive osteosynthesis of intra-articular calcaneal fractures

The approach to the treatment of intra-articular calcaneal fractures has of ten been the subject of discussion. The results achieved with both operativ e and non-operative management remain to some extent unpredictable. Minimal ly invasive osteosynthesis offers an alternative approach, especially in th ose cases in which open reduction would be hazardous and non-operative trea tment inadequate. This technique requires minimal dissection and preserves subtalar motion almost completely. The authors believe that displaced intra-articular calcaneal fractures are best treated through operative intervention. Restoration of articular congr uity is an integral, though not necessarily sufficient, component of a succ essful long-term outcome following calcaneal fracture. The extra-articular dimensions of the calcaneus must be restored in order to tolerate standard shoe-wear, maintain a functional range of talocalcaneal motion and avoid su bsequent tibiotalar arthrosis. However, in certain circumstances open reduc tion may be associated with an unacceptably high complication rate. In thes e cases, the authors have found a "minimally invasive" osteosynthesis techn ique useful in dealing with competing goals. In our experience, this techni que can, when used appropriately, result in a functional. recovery of the p atient suffering a calcaneal fracture.