Minimally invasive percutaneous fixation of displaced intra-articular calcaneal fractures: Surgical technique and case series from a major trauma centre

Ashwin Bhadresha; Iris Kwok; Harry Hodgson; Islam Abdelrahman; Nadeem Mushtaq; Naveethan Sivanadarajah

doi:10.1016/j.foot.2026.102285

Minimally invasive percutaneous fixation of displaced intra-articular calcaneal fractures: Surgical technique and case series from a major trauma centre

Foot (Edinb). 2026 Jul 17:68:102285. doi: 10.1016/j.foot.2026.102285. Online ahead of print.

Authors

Ashwin Bhadresha¹, Iris Kwok², Harry Hodgson², Islam Abdelrahman², Nadeem Mushtaq², Naveethan Sivanadarajah²

Affiliations

¹ St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, United Kingdom. Electronic address: a.bhadresha@nhs.net.
² St Mary's Hospital, Imperial College Healthcare NHS Trust, Praed Street, London, W2 1NY, United Kingdom.

PMID: 42468064
DOI: 10.1016/j.foot.2026.102285

Abstract

Introduction: Displaced intra-articular calcaneal fractures (DIACFs) managed with open reduction internal fixation through extensile lateral or sinus tarsi approaches are associated with a high rate of soft tissue complications. We present the technique of minimally invasive percutaneous fixation of DIACFs and the early outcomes from a major trauma centre.

Methods: This was a retrospective case series from a single major trauma centre between 2021 and 2024. Seventeen DIACFs in 13 patients were followed up for a mean of 14 months (range, 12-16 months). The mean age was 41 years (range, 18-60 years). Two out of 17 fractures were open injuries. There were seven Sanders type 2 and ten Sanders type 3 fractures. Simple tongue-type fractures were excluded. Fracture reduction was performed using a Schanz pin, combined with the 'Essex-Lopresti manoeuvre' and manual correction of varus and shortening. Fixation was with at least three 6.5 mm partially-threaded cancellous screws. Patients were immobilised in a below knee backslab for 6-weeks post-operatively. Radiological parameters (Böhler's angle, calcaneal height and width), the Kerr-Atkins score, VAS pain score, and any re-operations or complications were recorded.

Results: At final follow-up, the mean Kerr-Atkins score was 67 and the mean VAS pain score was 3.4. The average time from injury to surgery was 6.9 days (range, 3-21). All patients were mobilising unaided, and only 2 patients required orthotic footwear. One patient had a re-operation due to a late-declaring necrotic eschar. Mean Böhler's angle increased from 14.9° to 26.8° (p < 0.0001). The mean calcaneal height increased from 38.7 mm to 45.4 mm (p < 0.0001). No patients had developed clinical or radiological subtalar arthritis during the study period.

Conclusion: In our case series, we have demonstrated that minimally invasive percutaneous fixation of DIACFs is a safe procedure, with a very low complication rate. Early functional and radiological outcomes are excellent, with all patients mobilising unaided, and most were able to wear normal footwear with a plantigrade, shoeable foot.

Keywords: Calcaneal fractures; Displaced intraarticular; Minimally invasive; Percutaneous fixation.