Acta Scientific Orthopaedics (ISSN: 2581-8635)

Case Report Volume 5 Issue 11

Primary Subtalar Arthrodesis with Percutaneous Screw Fixation and Bone Grafting Through Mini-Open Sinus Tarsi Approach for Sanders Type IV Bilateral Calcaneal Fracture - Three-Year Follow-Up Case Report

Zelimir J Jovanovic1*, Lazar D Miceta1,2*, Nemanja S Jovanovic1, Danilo T Jeremic1,2 and Nemanja S Slavkovic1,2

1Department of General Orthopaedics, Institute for Orthopaedics “Banjica“, Serbia
2Medical Faculty University of Belgrade, Dr Subotica, Belgrade, Serbia

*Corresponding Author: Zelimir J Jovanovic, Department of General Orthopaedics, Institute for Orthopaedics “Banjica“, Serbia.

Received: July 18, 2022; Published: October 13, 2022


Introduction: Calcaneus fractures are rare but potentially debilitating injuries. Most of them are displaced intraarticular fractures, which management represents one of the controversial issues. There is no consensus on whether to operate or not. The most often chosen surgical treatment is open reduction and internal fixation as the primary method. Failure of this surgery often needs secondary subtalar arthrodesis as definitive management, so primary subtalar arthrodesis in cases with severe comminution represents definitive treatment in one stage with good functional results.

Case Presentation: We present the case of a 54-year-old male patient with severely comminuted (Sanders type IV) bilateral calcaneus fracture. After the withdrawal of local swelling and disappearance of fracture, blisters patient was operated on using one-stage bilateral subtalar arthrodesis with percutaneous screw fixation and bone grafting performed through a mini-open sinus tarsi approach. The early postoperative period went unremarkably. The patient did not walk for the first seven postoperative weeks, after which rehabilitation was continued with partial-weight bearing with a gradual increase of weight-bearing to full through the next five weeks, after which walking aids were completely phased out. Three years after surgery patient has no symptoms and has a close-to-normal gait.

Conclusion: Although this type of injury has traditionally been treated with open reduction and internal fixation, we believe that primary subtalar arthrodesis with bone grafting through a mini-open sinus tarsi approach can benefit patients with severe comminution of calcaneus, allowing good functional results and patient satisfaction, with fewer postoperative complications and faster definitive recovery

Keywords: Intra-Articular Fractures; Calcaneus; Subtalar Joint; Arthrodesis


  1. Singh A., et al. “Effect of Bone Grafting in Short- and Long-Term Outcomes of Displaced Intra- Articular Calcaneal Fractures: A Prospective Comparative Study”. International Journal of Orthopaedics1 (2016): 505-511.
  2. Potenza V., et al. “Primary subtalar arthrodesis for the treatment of comminuted intra-articular calcaneal fractures”. Injury7 (2010): 702-706.
  3. Sharr P., et al. “Current management options for displaced intra-articular calcaneal fractures: Nonoperative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review”. Foot and Ankle Surgery 1 (2016): 1-8.
  4. Buckley R., et al. “Operative compared with nonoperative treatment of displaced intraarticular calcaneal fractures: A prospective, randomized, controlled multicenter trial”. The Journal of Bone and Joint Surgery 84-A (2002): 1733-1744.
  5. Holmes GB. “Treatment of Displaced Calcaneal Fractures Using a Small Sinus Tarsi Approach”. Techniques in Foot and Ankle Surgery1 (2005): 35-41.
  6. Buckley R., et al. “Open Reduction and Internal Fixation Compared with ORIF and Primary Subtalar Arthrodesis for Treatment of Sanders Type IV Calcaneal Fractures”. Journal of Orthopaedic Trauma10 (2014): 577-583.
  7. Schepers T. “The primary arthrodesis for severely comminuted intra-articular fractures of the calcaneus: A systematic review”. Foot and Ankle Surgery2 (2012): 84-88.
  8. Huefner T., et al. “Primary Subtalar Arthrodesis of Calcaneal Fractures”. Foot and Ankle International 1 (2001): 9-14.
  9. Almeida JF., et al. “Osteosynthesis or primary arthrodesis for displaced intra-articular calcaneus fractures Sanders type IV - A systematic review”. Foot and Ankle Surgery3 (2021): 281-287.
  10. Sanders R., et al. “Operative Treatment in 120 Displaced Intraarticular Calcaneal Fractures”. Clinical Orthopaedics and Related Research 290 (1993): 87-95.


Citation: Zelimir J Jovanovic., et al. “Primary Subtalar Arthrodesis with Percutaneous Screw Fixation and Bone Grafting Through Mini-Open Sinus Tarsi Approach for Sanders Type IV Bilateral Calcaneal Fracture - Three-Year Follow-Up Case Report ". Acta Scientific Orthopaedics 5.11 (2022): 91-95.


Copyright: © 2022 Zelimir J Jovanovic., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Acceptance rate33%
Acceptance to publication20-30 days

Indexed In

News and Events

  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is July 10, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"
  • Welcoming Article Submission
    Acta Scientific delightfully welcomes active researchers for submission of articles towards the upcoming issue of respective journals.

Contact US