Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts’ review

Abstract

Introduction A large variety of therapeutic modalities for calcaneal fractures have been described in the literature. No single treatment modality for displaced intra-articular calcaneal fractures has proven superior over the other. This review describes and compares the diVerent percutaneous distractional approaches for intra-articular calcaneal fractures. The history, technique, anatomical and fracture considerations, limitations and the results of diVerent distractional approaches reported in the literature are reviewed. Method Literature review on diVerent percutaneous distractional approaches for displaced intra-articular calcaneal fractures. Results Eight studies in which application of a distraction technique was used for the treatment of calcaneal fractures were identiWed. Because of the use of diVerent classiWcation, techniques, and outcome scoring systems, a metaanalysis was not possible. A literature review reveals overall fair to poor result in 10-29% of patients. Ten up to 26% of patients are unable to return to work after percutaneous treatment of their fracture. A secondary arthrodesis has to be performed in 2-15% of the cases. Infectious complications occur in 2-15%. Some loss of reduction is reported in 4-67%. Conclusion Percutaneous distractional reduction and Wxation appears to be a safe technique with overall good results and an acceptable complication rate, compared with other treatment modalities for displaced intra-articular calcaneal fractures. A meta-analysis, based on Cochrane Library criteria is not possible, because of a lack of level 1 and 2 trials on this subject.