Primary Subtalar Arthrodesis In Comminuted Calcaneal Fractures

Calcaneal fractures represent about 60% of tarsal fractures, mostly in males in their productive age resulting in a considerable economic impact, often leave severe daily disabilities and also affect working capacity. (1)These fractures are still a major challenge for orthopedic surgeons because of the controversy in terms of management.(2)Calcaneal fractures are almost always the result of high-energy injuries mostly resulting from fall from a height, other causes include motor car accidents, suicidal attempts and sports injuries. (3)Calcaneal fractures are divided into two broad categories; intra-articular and extraarticular fractures. While the treatment of the extra-articular fractures is relatively simple, numerous controversies surround the understanding of the treatment of the intra-articular calcaneal fractures. (4)Conservative treatment could be considered in extra-articular fractures and in minor displaced intra-articular fractures. Surgically unfit patients should receive conservative treatment.(5)Open reduction and internal fixation is gaining much popularity for the treatment of the displaced intra-articular calcaneal fractures at many orthopedic trauma centers.(6)As a better understanding of fracture patterns with recent advances in imaging, modern surgical techniques and hardware had improved outcomes and lowered morbidity, a trend has developed toward ORIF for displaced intra-articular calcaneal 
fractures. (7)The key to achieve best results in the displaced calcaneal fractures is anatomic reconstruction of the entire calcaneum. This includes restoration of the articular surface, height, length and alignment of the calcaneus and a function directed postoperative management. (8)Intra-articular calcaneal fractures often result in a varus deformity with heel widening, loss of calcaneal height, and subtalar articular incongruency. ORIF can be used to address these deformities, restoring the anatomic morphology of the calcaneus and thereby the biomechanics and function of the hindfoot.(9)Restoring heel width prevents chronic peroneal tendinitis secondary to impingement from lateral wall blow-out of the calcaneus (10),(11),(12) and restoring length and alignment of the Achilles tendon maintains plantar-flexion strength.(13)ORIF also provides the opportunity for anatomic reduction and rigid internal fixation of the subtalar joint. (9)
However, all cases treated conservatively & many cases treated with ORIF usually end in subtalar arthritis which may finally lead to subtalar arthrodesiss. (14