• Tim Schepers, Lucas M M Vogels, Inger B Schipper, and Peter Patka.
• Department of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Room H974, 3000 CA, Rotterdam, The Netherlands. t.schepers@erasmusmc.nl
• Oper Orthop Traumatol. 2008 Jun 1;20(2):168-75.

ObjectivePercutaneous reduction by distraction and subsequent percutaneous screw fixation to restore calcaneal and posterior talocalcaneal facet anatomy. The aim of this technique is to improve functional outcome and to diminish the rate of secondary posttraumatic arthrosis compared to conservative treatment and, secondly, to reduce infectious complications compared to open reduction and internal fixation (ORIF).IndicationsSanders type II-IV displaced intraarticular calcaneal fractures.ContraindicationsIsolated centrally depressed fragment. Patients who are expected to be noncompliant.Surgical TechniqueFour distractors (Synthes) are positioned, two on each side of the foot, between the tuberosity of the calcaneus and talus and between the tuberosity and cuboid. A distracting force is given over all four distractors. A blunt drifter is then introduced from the plantar side to unlock and push up any remaining depressed parts of the subtalar joint surface of the calcaneus. The reduction is fixated with two or three screws inserted percutaneously.Postoperative ManagementDirectly postoperatively, full active range of motion exercises of the ankle joint can start, with the foot elevated in the 1st postoperative week. Stitches are removed after 14 days. Implant removal is necessary in 50-60% of patients.ResultsBetween 1999 and 2004, 59 patients with 71 fractures were treated by percutaneous skeletal triangular distraction and percutaneous fixation. A total of 50 patients with 61 fractures and a minimum follow-up of 1 year were available for follow-up. According to the American Orthopaedic Foot and Ankle Society Hindfoot Score, 72% had a good to excellent result. A secondary subtalar arthrodesis was performed in five patients and planned in four (total 15%). Böhler's angle increased by about 20 degrees postoperatively. Sagittal motion was 90% and subtalar motion 70% compared to the healthy foot.

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