Medial percutaneous reduction of calcaneal fracture using a two pin ratcheting joint distractor: A case report

Abstract

Background: Reduction of calcaneal fractures using the sinus tarsi approach can be challenging due to limited visualization of the fragment fragments and lack of direct access for reduction instrumentation. The present study introduces a modified reduction technique using a percutaneously placed two pin joint distractor along the medial wall of the calcaneus to assist with reduction. Case Study: We present the treatment of a 44-year-old male with Sanders IV calcaneus fracture. Multiple reduction techniques were attempted through a sinus tarsi approach including use of a traction pin through the calcaneal tuberosity. Adequate reduction was then attained using a two-pin joint distractor inserted percutaneously along the medial aspect of the calcaneus at the sustentaculum tali and tubor. Adequate reduction with this method provided adequate reduction for definitive fixation. This technique has been reproducible at our institution. Conclusions: The technique described in the present study may assist surgeons in the reduction of difficult calcaneus fractures with minimal invasiveness. The technique can be used to realign the calcaneus with minimal soft tissue dissection and can be performed immediately following injury in instances of extensive soft tissue swelling. Percutaneous reduction avoids the risk of wound complications and infection that is common with the lateral extensile approach. Minimally invasive reduction and fixation of the calcaneus as described is technically demanding, and hindfoot osteology and surface anatomy should be understood.

Keywords

• Trauma
• Calcaneus
• Fracture
• Reduction
• Percutaneous
• Hindfoot