Reconstructive osteotomy of calcaneus for malunited calcaneal fractures.

Objective To investigate the feasibility of reconstructive osteotomy of calcaneus for malunited calcaneal fractures. Methods From August 2004 to May 2007, 25 cases with 28 calcaneal malu-nion for 1.5 to 12 months(average 4.6 months) were treated by reconstructive osteotomy of calcaneus. Accord-ing to Zwipp and Rammelt classification for malunited calcaneal fractures, 12 calcaneal were type Ⅲ,16 type Ⅳ. All patients underwent radiography including axial, lateral views and CT imaging for calcaneus, and three-dimensional CT imaging reconstruction for 12 cases. According to Essex-Lopresti and Sander classifi-cation, and combining with primary X-ray film, reconstructive osteotomy was performed through the primary fracture line. According to widening of the sustentaculum of talus and pitch of fracture, the osteotomy line was from superior anterolateral to inferior posteromedial. The posterior subtalar facet was reduced by elevat-ing the fragment of the posterior subtalar facet upwards and backwards. The defect of calcaneus was filled with the bone graft resected from the extruding lateral wall of calcaneus, or iliac crest bone autografts. The calcaneus was fixed with plate and screw. Results Twenty-four cases with 26 feet were followed up for an average of 12 months (range, 10-16 months). Wound infection happened in 2 cases, which healed after the interfixed plate was removed. There were no screw breakage and displacement of the fracture. The average time for bone healing was 12 weeks(range, 10-14 weeks). The postoperatively functional evaluation by Mary-land score system revealed excellent result in 10 feet, good in 12, fair in 4. The rate of excellent and good results was 84%. Conclusion Reconstructive osteotomy recreating the primary fracture could facile restore the posterior facet and correct the varus and valgus deformity. Remained subtalar joint could reduce the in-fluence of operation for the function of the foot and ankle joint. The results were satisfactory in recently. Key words: Calcaneus;  Fractures;  Abnormalities