Minimally Invasive Treatment of Inversion Shortening Calcaneal Fractures in the “Out‐In” Position

Objective Heel fractures need extensive surgical incisions and are challenging to successfully reposition using traditional prying. The goal of this study is to evaluate the clinical effectiveness of using a Kirschner pin‐guided distractor to treat inversion shortening calcaneal fractures in the “out‐in” position. Methods A total of 40 data from 37 patients with inversion shortened calcaneal fractures from January 2018 to March 2020 were reviewed. Preoperative lateral and axial X‐rays and 3D CT were taken to assess the fracture type, and minimally invasive internal fixation was performed in the “out‐in” position with distractor repositioning, and intraoperative and postoperative images were taken to assess fracture repositioning and fixation. During the follow‐up period, the postoperative functional recovery status was assessed using the VAS score, AOFAS score, and FAOS score. Paired‐samples t‐test was used for all data comparisons. Results All cases received a mean follow‐up of 28.49 ± 3.25 months, and the mean fracture healing time was 7.84 ± 0.71 weeks. The postoperative images showed well‐fixed fracture repositioning, and calcaneal height, length, width, and inversion angles were significantly improved. At the final follow‐up, the calcaneal height, length, and width recovered from 39.35 ± 4.44mm, 79.35 ± 2.7mm, and 45.75 ± 2.87mm preoperatively to 50.93 ± 3.18mm, 82.23 ± 1.90mm, and 39.67 ± 1.58mm postoperatively ( p < 0.001; p < 0.001; p < 0.001). The calcaneus inversion angle restored from 7.73° ± 2.26° to 3.80° ± 1.80° ( p < 0.001). Böhler's angle and Gissane's angle improved from 13.13° ± 3.02° and 105.15° ± 8.94° to 27.95° ± 3.41° and 122.85° ± 5.54° ( p < 0.001; p < 0.001). No non‐healing fractures, osteomyelitis, or traumatic arthritis were observed. Conclusion Minimally invasive internal fixation with distractor repositioning in the “out‐in” position is effective in the treatment of inversion shortening calcaneal fractures while restoring the anatomy and protecting the soft tissue.