Summary. Relevance. Calcaneus non-union (CNU) occurs in 1.3% of fracture cases; however, according to different authors, the frequency of this complication is much higher and is about 10%.
Objective: to describe the clinical and roentgenological findings in patients with CNU; to highlight important aspects of diagnostics and surgical treatment.
Materials and Methods. 9 patients with CNU have been observed. There were 7 males and 2 females. The average age was 34±1.5 (range 23-52) years. The average term from trauma to surgery was 13.5±1.5 (range 6-21) months. Changes in vertical talus-first metatarsal angle (vT1MA), pain syndrome (VAS), ankle range of motion, and foot function using AOFAS have been investigated. The indication for surgical treatment was symptomatic foot deformity; a subtalar arthrodesis with bone graft was used.
Results. CNU was observed in 7 cases (77.8%) after the conservative treatment and in 2 cases (22.2%) after the surgical treatment. Roentgenologycally, the most characteristic feature was the extensor position of the talus and the associated with it the positive value of vT1MA, which causes an inverse relationship with the range of extension of the foot and reduces the height of the calcaneus. A subtalar arthrodesis with bone graft was performed in 7 cases (77.8%); in 2 cases (22.2%), the procedure was combined with calcaneus closing wedge osteotomy because of significant loss of hindfoot height. Bone fusion occurred within 8-10 weeks. vTMFA was 13±10 (13-150) before surgery and 8±10 (8-100) after surgery. Functional result by AOFAS was 63±2 points before surgery and 84±2 points 6 months after surgery.
Conclusions. Calcaneus non-union is not accompanied by pain syndrome and is detected when the patient consults a doctor. The necessity of surgery in this case is decided on the basis of a detailed clinical and X-ray analysis and CT of the foot, taking into account the deformity of the hindfoot and the need for correction.
Thomas P, Wilson LF. Non-union of an os calcis fracture. Injury. 1993 Oct;24(9):630-2. DOI: 10.1016/0020-1383(93)90132-p.
Natera Cisneros L, Moya Gómez E, Gonzalez Lucena G, Trullols L, Soria L, Peiró A. Pseudoartrosis de calcáneo en contexto de pie catastrófico. Revista Cubana de Ortopedia y Traumatología [Internet]. 2014 Disponible en: http://www.revortopedia.sld.cu/index.php/revortopedia/article/view/14.
Natera-Cisneros L, Moya-Gómez E, Gonzalez-Lucena G, Trullols L, Soria L, Peiró A. Calcaneal pseudoarthrosis in the context of catastrophic foot. Cuban Journal of Orthopedics and Traumatology [Internet]. 2014 Available at: http://www.revortopedia.sld.cu/index.php/revortopedia/article/view/14 [in Spanish].
Zwipp H, Tscherne H, Thermann H, Weber T. Osteosynthesis of displaced intraarticular fractures of the calcaneus. Results in 123 cases. Clin Orthop Relat Res. 1993 May;(290):76-86.
Li Y, Bao RH, Jiang ZQ, Wu HY. Complications in operative fixation of calcaneal fractures. Pak J Med Sci. 2016 Jul-Aug;32(4):857-62. DOI: 10.12669/pjms.324.10225.
Thermann H, Hüfner T, Schratt HE, Held C, Tscherne H. Die subtalare Fusion nach konservativ oder operativ behandelter intraartikulärer Kalkaneusfraktur. Ein Vergleich der Langzeitergebnisse. Unfallchirurg. 1999 Jan;102(1):13-22. DOI: 10.1007/s001130050367.
Thermann H, Hüfner T, Schratt HE, Held C, Tscherne H. Subtalar fusion after conservative or surgical treatment of calcaneus fracture. A comparison of long-term results. Unfallchirurg. 1999 Jan;102(1):13-22. [in German]. DOI: 10.1007/s001130050367.
Molloy AP, Myerson MS, Yoon P. Symptomatic nonunion after fracture of the calcaneum. Demographics and treatment. J Bone Joint Surg Br. 2007 Sep;89(9):1218-24. DOI: 10.1302/0301-620X.89B9.19105.
Schepers T, Patka P. Calcaneal nonunion: three cases and a review of the literature. Arch Orthop Trauma Surg. 2008 Jul;128(7):735-8. DOI: 10.1007/s00402-007-0516-3.
Kumar N. Non-union of calcaneum – A rare complication of calcaneal fracture – A case report with brief review of literature. J Clin Orthop Trauma. 2015 Sep;6(3):187-9. DOI: 10.1016/j.jcot.2015.02.005.
Assous M, Bhamra MS. Should Os calcis fractures in smokers be fixed? A review of 40 patients. Injury. 2001 Oct;32(8):631-2. DOI: 10.1016/s0020-1383(00)00130-3.
Zhang W, Chen E, Xue D, Yin H, Pan Z. Risk factors for wound complications of closed calcaneal fractures after surgery: a systematic review and meta-analysis. Scand J Trauma Resusc Emerg Med. 2015 Feb 8;23:18. DOI: 10.1186/s13049-015-0092-4.
Gehr J, Schmidt A, Friedl W. Die Kalkaneuspseudarthrose. Eine klinische Rarität. Unfallchirurg. 2000 Jun;103(6):499-503. DOI: 10.1007/s001130050572.
Gehr J, Schmidt A, Friedl W. Calcaneus pseudarthrosis: a clinical rarity. Unfallchirurg. 2000 Jun;103(6):499-503. DOI: 10.1007/s001130050572. [in German].
Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. 5th ed. Philadelphia: F.A. Davis Company; 2016. 592 р.
Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994 Jul;15(7):349-53. DOI: 10.1177/107110079401500701.
Schindler C, Schirm A, Zdravkovic V, Potocnik P, Jost B, Toepfer A. Outcomes of intra-articular calcaneal fractures: surgical treatment of 114 consecutive cases at a maximum care trauma center. BMC Musculoskelet Disord. 2021 Mar 1;22(1):234. DOI: 10.1186/s12891-021-04088-w.
Schepers T, Kieboom BC, Bessems GH, Vogels LM, van Lieshout EM, Patka P. Subtalar versus triple arthrodesis after intra-articular calcaneal fractures. Strategies Trauma Limb Reconstr. 2010 Aug;5(2):97-103. DOI: 10.1007/s11751-010-0084-x.
Wajdi B, Rebai MA, Baya W, Krid N, Zribi W, Keskes H. Pseudarthrosis of the Calcaneus: Advantages of Regenerative Medicine in the Management of a Rare Entity, A Case Report and Review of Literature. Open Orthop J. 2018 Mar 30;12:141-146. DOI: 10.2174/1874325001812010141.
Sherehii AA, Stoika VV, Lytvak VV. A rare complication of calcaneal fracture – calcaneal non-union. Case report. Wiad Lek. 2021;74(4):1042-44. PMID: 34156027.
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