Primary Subtalar Arthrodesis Versus Late Subtalar Arthrodesis in Sanders Type IV Calcaneal Fractures
Calcaneus Fracture
About this trial
This is an interventional treatment trial for Calcaneus Fracture focused on measuring Primary subtalar arthrodesis, Late subtalar fusion
Eligibility Criteria
Inclusion Criteria:
- Patients with a Sanders IV displaced intra-articular calcaneal fracture (DIACF).
- Within 12 months from injury.
- Clear demonstration of at least 3 fracture lines across the posterior subtalar facet, dividing it into at least 4 fragments and the fragments being displaced by at least 2 mm, as seen on the coronal and axial CT scans (classified as Sanders IV).
- Ability to provide informed consent.
- Available for follow-up for at least 6 months after intervention.
Exclusion Criteria:
- Medical contraindications to surgery.
- Fracture more than 12 months old at first presentation.
- Previous calcaneal pathology (infection, tumor etc).
- Previous calcaneal surgery.
- Co-existent foot or ipsilateral lower limb injury.
- Open calcaneal fractures.
- Inability to obtain preoperative CT scans or accurately classify the fractures as per Sanders classification system.
Sites / Locations
- Ain shams university hospital
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
Group A: open reduction and internal fixation plus primary subtalar arthrodesis.
Group B: conservative management then calcaneoplasty and subtalar arthrodesis.
they will be scheduled to surgery after resolution of the edema and appearance of wrinkle sign. Lateral position and lateral extensile approach will be used. A 4 mm schanz will be inserted in the calcaneal tuberosity from lateral side to control varus and to restore calcaneal height. Lateral wall of the calcaneus will be lifted keeping it attached inferiorly. Articular surfaces of inferior surface of the talus and posterior facet of the calcaneus will be debrided thoroughly and drilled by 2 mm k-wire. tricortical iliac bone autograft will be inserted the subtalar joint. A lateral nonlocked plate will be applied to reduce the lateral wall blow out and broadening then fixation by two cannulated partially threaded 7.3 screws from the calcaneal tuberosity to the talus. We will check position by fluoroscopy then closure in two layers (subcutaneous and skin) after homeostasis. Below knee slab will be applied and non-weight bearing for six weeks.
they will be assessed upon 1st clinic visit. After at least three months patients will be scheduled for subtalar arthrodesis. A new preoperative ankle CT scan will be done. Lateral position and lateral extensile approach will be used. Lateral wall and plantar exostosis will be resected. Articular surfaces of inferior surface of the talus and posterior facet of the calcaneus will be debrided thoroughly and drilled by 2 mm k-wire. Hind foot deformity (mostly varus) will be corrected through the subtalar joint manually and checked clinically. Loss of calcaneal height will be corrected by tricortical iliac bone autograft to distract the subtalar joint then fixation by two cannulated partially threaded 7.3 screws from the calcaneal tuberosity to the talus. We will check position by fluoroscopy then closure in two layers (subcutaneous and skin) after homeostasis. Below knee slab will be applied and non-weight bearing for six weeks.