title: Reconstruction of calcaneal fracture malunion with osteotomy and subtalar joint salvage: technique and outcomes.
abstract: BACKGROUND
  The goal of this study was to discuss the outcomes of treating calcaneal fracture malunion by restoring the subtalar joint with a reconstructive osteotomy.
  
  
  METHODS
  From May 2005 to November 2008, 24 patients (26 feet) with calcaneal malunions after a displaced intra-articular calcaneal fracture were treated by osteotomy and autogenous bone graft. The subtalar joint was preserved. The mean time from initial injury to reconstructive operation was 5.7 months (95% confidence interval, 4.5-8.8 months). The displaced posterior facet was restored through a reconstructive osteotomy, whereas the bone defect in the calcaneus after reduction was filled with the exostosis that had been removed; iliac bone graft was used if necessary. All patients were evaluated clinically and radiographically at a minimum of 24 months. Twenty patients (21 feet) were followed for a mean of 34.2 months (29.0-39.4 months).
  
  
  RESULTS
  According to American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, the average score was 85.9 points (95% confidence interval, 81.5-90.4 points), which was significantly higher than the preoperative assessment. Radiographs showed that Böhler's angle, Gissane's angle, talus declination angle, and width and height of calcaneus were improved to a great extent. Six patients had wound edge necrosis, and 2 had superficial infection. One patient required a subtalar fusion for subtalar arthritis at 2 years after surgery.
  
  
  CONCLUSIONS
  Restoring the subtalar joint with a reconstructive osteotomy and autogenous bone graft was an effective treatment method for selected calcaneal fracture malunions. It reconstructed calcaneal morphology and preserved the subtalar joint.
  
  
  METHODS
  Level IV, retrospective case series.
authors: Orthopaedic Surgery Department, Tongji Hospital of Tongji University, Shanghai, China. ygangrong2000@yahoo.com.cn
authors: Guang-Rong
authors: GR
authors: Yu
authors: Sun-Jun
authors: SJ
authors: Hu
authors: Yun-Feng
authors: YF
authors: Yang
authors: Hong-Mou
authors: HM
authors: Zhao
authors: Shi-Min
authors: SM
authors: Zhang
mesh_terms: D000328:Adult; D001178:Arthroplasty / Q000379:methods*; D002111:Calcaneus / Q000293:injuries*; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010027:Osteotomy; D018579:Patient Selection; D011859:Radiography; D020127:Recovery of Function; D013380:Subtalar Joint / Q000293:injuries*; D016896:Treatment Outcome; D055815:Young Adult
keywords: calcaneal fracture; malunion; osteotomy; outcome; subtalar joint; treatment