Treatment of Displaced Intra-articular Calcaneal Fractures With an Interlocking Nail (C-Nail)

OBJECTIVES:To assess the outcome of the sinus tarsi approach and C-Nail fixation of displaced intra-articular calcaneal fractures (DIACFs). DESIGN:Prospective study. SETTING:University Trauma Department. PATIENTS:Sixty-four patients (mean age 44.3 years, 48 men and 16 women) with 75 displaced intra-articular calcaneal fractures were treated between October 1, 2016 - December 31, 2018. INTERVENTION:In all cases, the posterior facet was reduced through the sinus tarsi approach and fixed with one or two screws. After reducing all fragments to the articular block, the final fixation was performed percutaneously with C-Nail, locked with six screws. MAIN OUTCOME MEASUREMENTS:Patients were assessed for restoration of the Böhler’s angle, complications, and overall fracture reduction. To assess the functional outcome, we used the Mean American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Score (AOFAS-AHS) and Maryland Foot Score (MFS) after 12 months. RESULTS:The Böhler’s angle improved from -0.5° preoperatively to 28.6° postoperatively. The articular step-off was reduced from 5.4 mm preoperatively to 0.6 mm postoperatively. The postoperative radiologic calcaneal score (RCS) was 2.9, on average. Superficial wound edge necrosis was seen in three patients (4%) and superficial infection was observed in one (1.3%). After a 1-year follow-up, we recorded a mean AOFAS-AHS score of 90.2 and a mean MFS score of 91.2. CONCLUSIONS:After obtaining an anatomic reduction of the articular surface of the posterior facet with lag screws, the C-Nail represented a viable alternative to plate stabilization in the treatment of displaced intra-articular calcaneal fractures, combining primary stability with low soft tissue complications. LEVEL OF EVIDENCE:Therapeutic Level IV.