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Journal of Bone and Joint Surgery - British Volume, Vol 89-B, Issue 9, 1218-1224.
doi: 10.1302/0301-620X.89B9.19105  
Copyright © 2007 by British Editorial Society of Bone and Joint Surgery
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Symptomatic nonunion after fracture of the calcaneum

DEMOGRAPHICS AND TREATMENT

A. P. Molloy, MBChC, MRCS, FRCS(Tr & Orth), Fellow1; M. S. Myerson, MD, Medical Director1; and P. Yoon, MD, Fellow1

The Institute for Foot and Ankle Reconstructive Surgery Mercy Medical Centre, 301 St Paul Place, Baltimore, Maryland 21202, USA.

Correspondence should be sent to Mr A. P. Molloy; e-mail: orthoblue{at}aol.com

We have treated 14 patients (15 fractures) with nonunion of an intra-articular fracture of the body of the calcaneum. The mean follow-up was six years (2 to 8.5). A total of 14 fractures (93%) had initially been treated operatively with 12 (86%) having non-anatomical reductions. Four feet (27%) had concomitant osteomyelitis. Of the nonunions, 14 (93%) went on to eventual union after an average of two reconstructive procedures. All underwent bone grafting of the nonunion. The eventual outcome was a subtalar arthrodesis in ten (67%) cases, a triple arthrodesis in four (27%) and a nonunion in one (6%). Three patients had a wound dehiscence; all required a local rotation flap. The mean American Orthopaedic Foot and Ankle Society score at latest follow-up was 69, and the mean Visual analogue scale was 3. Of those who were initially employed, 82% (9 of 11) eventually returned to work. We present an algorithm for the treatment of calcaneal nonunion, and conclude that despite a relatively high rate of complication, this complex surgery has a high union rate and a good functional outcome.




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M. R. Brinker, D. P. Loncarich, E. G. Melissinos, and D. P. O'Connor
Calcaneogenesis
J Bone Joint Surg Br, May 1, 2009; 91-B(5): 662 - 665.
[Abstract] [Full Text] [PDF]


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Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General