Utilization of a Lateral Based Femoral Distractor for Calcaneus Tuberosity Reduction in Displaced Intraarticular Calcaneus Fractures: Surgical Technique and Case Series

Abstract

Background: Displaced calcaneal fractures present significant challenges in achieving optimal reduction and fixation while minimizing complications. The traditional extensive lateral approach provides excellent exposure but is associated with high rates of wound complications, including infection and dehiscence. The sinus tarsi approach has gained popularity as a less invasive alternative, offering direct access to the posterior facet. However, it is limited in its ability to directly access and mobilize the calcaneal tuberosity, which is critical for restoring the height, length, and alignment of the calcaneus. This study describes a surgical technique with short term outcomes in which the sinus tarsi approach is combined with a laterally based femoral distractor which aids in manipulation and alignment of the calcaneal tuberosity. Methods: This retrospective study included 28 patients with displaced intra-articular calcaneal fractures (OTA/AO 82 C1-C3; Sanders type II-IV) treated at a level I academic center between 2020 and 2022. All fractures were managed using a combination of the sinus tarsi approach and a laterally based femoral distractor. Complications were recorded as well as comparison radiographic parameters both pre-and post-operatively.. Results: Complications included one case of superficial skin necrosis and two cases of implant removal due to pain. There were no instances of deep infection requiring unplanned return to the operating room. No loss of tuberosity reduction or subfibular impingement was observed at the final follow-up (mean follow-up 14 months). Conclusion: The combination of the sinus tarsi approach with femoral distractor use offers a method for reduction of displaced calcaneal fractures. This technique demonstrated appropriate restoration of hindfoot anatomy with reconstruction of height, length, width, and alignment in our patient cohort. This technique may potentially minimize the risk of complications compared to traditional methods, though further studies are needed to confirm these benefits and compare this technique with established approaches. Level of Evidence: IV.