Minimally-Invasive Repair of Bilateral Calcaneal Fractures with Unilateral External Fixation: A Case Report

Abstract

INTRODUCTION AND OBJECTIVES: Calcaneal fractures are a serious injury with significant associated morbidity. Bilateral calcaneal fractures complicate issues even further, due to the physical disability that the patient is left with. One of the major issues with any calcaneal fracture is the risk of soft tissue compromise caused by the traumatic nature of the injury. A percutaneous approach allows the soft tissue envelope to remain viable, while still fixating the fractures. The purpose of this presentation is to highlight the use of percutaneous repair, the role of external fixation in calcaneal fractures, and lastly discuss the outcome for this particular patient. METHODS: A 26 year-old male presented to the office with bilateral calcaneal fractures, approximately 1 week after sustaining a fall from a height of 12 feet. The patient was brought to the operating room after spending approximately 2 weeks in bilateral posterior splints with Jones compressive dressings. The right calcaneal fracture was fixated percutaneously with 4 screws. The left calcaneal fracture was fixated percutaneously with 3 screws, as well as an Ilizarov external fixator. Approximately 8 weeks later, the patient returned to the operating room for removal of the external fixator and a cast application to the left lower extremity. RESULTS: The patient continued to progress and was subsequently transitioned into bilateral CAM walkers. In the following weeks, the patient was again upgraded to full weight-bearing with physical therapy. The fracture sites were completely consolidated with minimal to no pain in his bilateral heels and full ambulation. CONCLUSIONS: Percutaneous repair, along with external fixation, offers a viable alternative to ORIF for calcaneal fractures. A percutaneous approach also does not disrupt the potentially fragile soft tissue envelope in a calcaneal fracture. Although this outcome is positive, larger controlled studies are needed to confirm percutaneous approaches and external fixation in the realm of a calcaneal fracture.

Background

Calcaneal fractures are a serious injury with significant associated morbidity. Although they compose 2% of all fractures reported in literature, the management and treatment remains the subject of great debate. Bilateral calcaneal fractures complicate issues even further, due to the physical disability that the patient is left with.

One of the major issues with any calcaneal fracture is the risk of soft tissue compromise caused by the traumatic nature of the injury. A percutaneous approach allows the soft tissue envelope to remain viable, while still fixating the fractures.

The purpose of this presentation is to highlight the use of percutaneous repair, the role of external fixation in calcaneal fractures, and lastly discuss the outcome for this particular patient.

Case History

A 26 year-old male presented to the office with bilateral calcaneal fractures, approximately 1 week after sustaining a fall from a height of 12 feet.

After spending approximately 2 weeks in bilateral posterior splints with Jones compressive dressings, the patient was brought to the operating room. Bilateral gastrocnemius recessions were performed first. The right calcaneal fracture was fixated percutaneously with 4 screws. The left calcaneal fracture was fixated percutaneously with 3 screws, as well as an Ilizarov external fixator.

Approximately 8 weeks later, the patient returned to the operating room for removal of the external fixator and a cast application to the left lower extremity. The patient continued to progress and was subsequently transitioned into bilateral CAM walkers.

In the following weeks, the patient was again upgraded to full weight-bearing with physical therapy. The fracture sites were completely consolidated with minimal to no pain in his bilateral heels and full ambulation.

Conclusion

This case offers a viable alternative to traditional ORIF for calcaneal fractures. The percutaneous approach, along with external fixation, does not disrupt the potentially fragile soft tissue envelope in a calcaneal fracture. It can also achieve adequate reduction of the fracture fragments and allow for early weight-bearing, which can help maintain range of motion.

Although this outcome is positive, larger controlled studies are needed to confirm percutaneous approaches and external fixation in the realm of a calcaneal fracture.