Corrective osteotomy for displaced fractures of the calcaneus using the Romash technique

   Introduction: displaced fractures of the calcaneus are a complex orthopedic problem, the optimal solution of which is a challenge for the surgeon. Such clinical cases are accompanied by a number of basic symptoms, which are caused by posttraumatic arthrosis of the subtalar and calcaneo-cuboid joints, impingement between the external ankle and the calcaneus (due to which there is dislocation and inflammation of the peroneal tendon sheaths), Impingement syndrome between the talus and tibia, due to the change in the normal angle of the talus and the associated impingement of the calf
nerve and not infrequent compression-ischemic neuropathy of the tibial nerve due to changes in the anatomy of the tarsal canal. We would like to present a method of correction of post-traumatic deformity of the calcaneus, which was first used in 1993 and described in detail by Romasch in 2006, thanks to which it is possible to solve the problems associated with impingement syndrome in the anterior ankle joint, due to the inclination of the posterior aspects of the talus, as well as the height and alignment with the axis of the tibia displaced on valgus and deformed as a result of trauma of the calcaneus. It consists in arthrodesis of the subtalar joint with oblique osteotomy of the calcaneus, recreating the primary fracture line, and subsequent repositioning of the fragments allows to obtain the desired anatomical and radiological picture. This distraction arthrodesis technique has the advantages of using “living” bone tissue to provide arthrodesis, instead of an intermediate bone graft, and the ability to correct the position of the hindfoot to a neutral position before fixation.

   Materials and methods: we performed 11 surgical interventions according to the proposed technique in patients with a long-standing posttraumatic deformity of the calcaneus.

   Results: we obtained positive results after the performed surgical interventions, correction of the calcaneal bone height by 1.5 cm and increase of the Belair angle by 25 degrees occurred.

1. Conn HR. The treatment of fractures of the os calcis.//J Bone Joint Surgery 1935, Vol. 17, P. 392. PMID: 5127968

2. Gallie WE. Substragalar arthrodesis in fractures of the os calcis.// J Bone Joint Surgery 1943, Vol.25, No. 4, P.731-736. PMID: 18894610

3. Carr JB, Hansen ST, Benirshke SK. Subtalar distraction bone block fusion for late complications of the os calcis fractures.// Foot Ankle. 1988, Vol.9, P. 81-86. doi: 10.1177/107110078800900204

4. Myerson, M; Quill, G E Jr. Late complications of fractures of the calcaneus.//The Journal of Bone & Joint Surgery 1993 Vol. 75, № 3, P. 331-341. PMID: 8444911

5. Romash MM. Reconstructive osteotomy of the calcaneus with subtalar arthrodesis for malunited calcaneal fractures.// Clin Orthopaedics Relat Res. 1993 Vol. 290, P. 157-167.PMID: 8472443

6. Burdeaux BD. Reduction of calcaneal fractures by the McReynolds medial approach technique and its experimental basis.// Clin Orthopaedics Relat Res. 1983, Vol. 199, P. 87-103

7. Leung K, Chan W, Shen W, et al. Operative treatment of intra articular fractures of the os calcis. The role of rigid internal fixation and primary bone grafting: preliminary results.// J Trauma. 1989; Vol. 3, P. 232-240 doi: 10.1097/00005131

8. Palmer I. The mechanism and treatment of fracture of the calcaneus: open reduction with the use of cancellous bone grafts.// J Bone Joint Surg. 1948 Vol. 30, P.2-8.

9. Bradley S A, Davies A M. Computerized tomographic assessment of old calcaneal fractures // Br J Radiol. 1990; Vol. 63, № 756, P. 926-933.

10. Hansen ST Jr. Functional reconstruction of the foot and ankle.// In: Calcaneal Osteotomy in Multiple Planes for Correction of Major Posttraumatic Deformity. Philadelphia: Lippincott Williams & Wilkins; 2000: P.380-383. ISBN 0397517521, 9780397517527