title: Subtalar distraction osteogenesis for posttraumatic arthritis following intra-articular calcaneal fractures.
abstract: BACKGROUND
  The most common treatment for old calcaneal fractures accompanied by subtalar joint injury is the use of subtalar in situ arthrodesis and subtalar distraction bone-block arthrodesis or osteotomy. This article describes the introduction of a novel surgical treatment, gradual subtalar distraction with external fixation and restoration of the calcaneal height, and presents an assessment of its efficacy.
  
  
  METHODS
  The protruding lateral calcaneus and the articular surfaces and subchondral bone of the posterior facet of the subtalar joint were surgically removed. An external fixator, attached with 2 pins in the subcutaneous tibia and 2 pins in the posterolateral calcaneus, was used to fix the subtalar joint for 7 to 10 days followed by gradual subtalar distraction at 1 mm/d. The lengthening procedure was stopped when the calcaneal height was restored according to radiography. The external fixator was removed after bone fusion. Seven cases of old calcaneal fractures accompanied by severe subtalar joint injury (8 feet) were treated using this method. Average follow-up was 14.3 months (range, 7-36 months).
  
  
  RESULTS
  In all 7 cases (1 case of both feet), the postoperative wound healed primarily. The calcaneal heights of all 8 feet were partially restored. Subtalar joint bone fusion was completed within 4 to 6 months after the operation. The average preoperative American Orthopedic Foot & Ankle Society (AOFAS) hindfoot score was 25.3, and the average postoperative AOFAS score was 76.3.
  
  
  CONCLUSIONS
  Subtalar distraction osteogenesis with external fixation was a novel and effective method for the treatment of old calcaneal fractures accompanied by severe subtalar joint injury in this small group of patients.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Orthopedics, Third Military Medical University, ChongQing, China.
authors.forename: Wei-Li
authors.initials: WL
authors.lastname: Fan
authors.forename: Hong-Zhen
authors.initials: HZ
authors.lastname: Sun
authors.forename: Si-Yu
authors.initials: SY
authors.lastname: Wu
authors.forename: Ai-Min
authors.initials: AM
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D001858:Bone Nails; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery*; D005260:Female; D018409:Foot Injuries / Q000150:complications*; D005593:Fracture Fixation, Internal / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D057072:Intra-Articular Fractures / Q000150:complications* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000209:etiology* / Q000601:surgery*; D019857:Osteogenesis, Distraction / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D013380:Subtalar Joint / Q000293:injuries* / Q000601:surgery*; D016896:Treatment Outcome