Varus malunion following surgery for intra-articular calcaneal fracture: Pearls and pitfalls

Objective To analyze the causes and countermeasures for varus malunion by retrospectively evaluating the surgery for intra-articular calcaneal fractures.Methods Between April 2011 and March 2013,totally 50 patients with intra-articular calcaneal fracture were enrolled into our study.They were 31 men and 19 women,25 to 64 years of age (average,44.8 years).When soft tissue swelling subsided,a limited open reduction and internal fixation(ORIF) via a sinus tarsi incision or an ORIF via a classical lateral extensile L-shape approach was performed.The alignment of hindfoot was evaluated and the yarus angle was measured via calcaneal axial view.Overall functional evaluation was carried out in the patients with varus malunion in terms of visual analogue scale (VAS) and the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS) at the last follow-up.Results Totally there were 27 cases of varus malunion,with a mean varus of 16.0° (from 8° to 25°).The average AOFAS ankle and hindfoot score was 49.8 (from 30 to 70) and the VAS score was 3.0 (from 1 to 8).Of them,24 were treated with the classical lateral extensile L-shape approach and 3 with limited ORIF.The varus malunion was caused by improper reduction in 21 cases and by secondary reduction loss due to screw convergence in 6 cases.Conclusions Unskillful reduction and fixation are pitfalls leading to calcaneal varus malunion.Surgeons should pay more attention to anatomic reduction and proper and stable fixation of the calcaneal medial column. Key words: Calcaneus;  Fractures, bone;  Fracture fixation, internal;  Malunion