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Minimal invasive mini-rail external fixation for surgical treatment of calcaneal fractures

The purpose of this study is to evaluate and promote the application of percutaneous minimal invasive uniplanar mini-rail external fixation for definitive fixation for displaced calcaneal fractures. This technique has been promoted to avoid soft tissue complications commonly seen with calcaneal open reduction internal fixation, and allows to apply skeletal traction and fracture reduction through ligamentotaxis with percutaneous fixation of the posterior facet fragments without the need to delay surgery secondary to edema. ​In this retrospective study, application of four 3.0mm stainless steel partially threaded half pins were applied across an intra-articular calcaneal fracture, 2 proximal and two distal, allowing for longitudinal traction and stabilization following reduction. Clinical outcomes were determined with a minimal 12-month follow up and a American Orthopedic Foot and Ankle Score (AOFAS) hindfoot score questionnaire. We evaluated and surgically managed 21 patients who presented to the emergency department with closed calcaneal fractures in a 6-year period, beginning from the year 2014 to 2020 with mini-rail fixation. Of the 21 patients, 12 (57%) participated in this study and were also evaluated by physical examination. Regarding patient satisfaction with minimal invasive percutaneous mini-rail fixation, patients reported an average AOFAS score of 82.1, 91% (11/12 patients) and were able to return to work, and only 1 patient required an additional surgery. The clinical results are comparable with traditional open reduction internal fixation with no soft tissue disruption, avoidance of internal fixation plates/screws, and allows for early mobilization.