title: Staged subtalar fusion for severe calcaneus fractures with bone loss.
abstract: BACKGROUND
  With high energy fractures to the calcaneus there is the potential for significant bone loss. The loss of bone can make it difficult to fully regain calcaneal alignment. In addition these fractures are often associated with significant soft tissue injury. These two factors make it difficult to address this injury in a single stage, and can have significant complications. To address these issues our initial goal in treatment has been restoration of calcaneal alignment and stabilization of the surrounding soft tissue, followed by delayed/staged subtalar arthrodesis.
  
  
  METHODS
  Patients with calcaneus fractures treated by a single surgeon from 2002 to 2012 were reviewed. Injuries which were found to have medial extrusion of the posterior facet and bone loss, and subsequently underwent a staged protocol involving early provisional fixation and late subtalar fusion were included.
  
  
  RESULTS
  We treated 6 calcaneus fractures with bone loss. All patients were treated with staged subtalar fusion after initial irrigation and debridement and provisional fixation. No soft-tissue complications were noted after the fusion procedure in any of the six cases. Fusion occurred in all six patients at an average of 20.6 weeks (range, 13-23 weeks). All patients were able to ambulate and wear a regular shoe by one year following the initial injury.
  
  
  CONCLUSIONS
  It is important in the high energy calcaneus fracture to assess for both soft tissue integrity and bone loss. A thorough debridement of both the soft tissues and any devitalized bone should be performed as well as provisional fixation which attempts to restore near normal calcaneal anatomy. Definitive fusion should not be performed until the soft tissues have fully recovered.
authors: Department of Orthopaedic Surgery, Sports Medicine & Rehabilitation, Wright State University Boonshoft School of Medicine, 30 E. Apple Street, Suite 2200, Dayton, OH 45409, USA.
authors: Chad G
authors: CG
authors: Williams
authors: Michael J
authors: MJ
authors: Coffey
authors: Peter
authors: P
authors: Shorten
authors: James D
authors: JD
authors: Lyions
authors: Richard T
authors: RT
authors: Laughlin
keywords: Bone loss; calcaneus; calcaneus fractures with bone loss.; open fracture