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 degrees +/- 2.26 degrees to 3.80 degrees +/- 1.80 degrees (p < 0.001). B & ouml;hler's angle and Gissane's angle improved from 13.13 degrees +/- 3.02 degrees and 105.15 degrees +/- 8.94 degrees to 27.95 degrees +/- 3.41 degrees and 122.85 degrees +/- 5.54 degrees (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.