Can An Emerging Locked Nailing System Enhance The Treatment Of Calcaneal Fractures?

An innovative procedure that uses locked nailing for the treatment of calcaneal fractures and subtalar arthrodesis may lead to fewer complications and better outcomes in patients requiring surgical intervention.

The Calcanail^® System employs a minimally invasive, closed technique using a nail and cannulated screws for the repair of displaced intra-articular fractures of the calcaneus as well as subtalar arthrodesis following intra-articular fracture of the calcaneus or degeneration of the subtalar joint, according to the manufacturer FH Ortho.

Surgeons would use a hollow reamer to tunnel into the calcaneus incorporating a through-the-heel approach. When employing this approach with a subtalar distractor, surgeons have direct intrafocal access to the articular fragments, according to the company. FH Ortho says the surgeon can subsequently apply percutaneous fixation to hold the reduced joint and calcaneus in place.

Guido LaPorta, DPM, MS, FACFAS, has used Calcanail to treat both calcaneal fractures and malunion of calcaneal fractures requiring subtalar joint fusion.  

“The key advantage of this system is the option to treat these situations with limited incisions and in a percutaneous manner, limiting dissection and lessening soft tissue complications,” says Dr. LaPorta, a Diplomate of the American Board of Foot and Ankle Surgery, and the American Board of Podiatric Medicine.

“The system provides instrumentation for reduction of joint depression fractures of the calcaneus, which can be used to manipulate joint fracture fragments,” notes Dr. LaPorta, the Chief of Foot and Ankle Surgery at Geisinger Community Medical Center in Scranton, Pa. He adds that the ability to lock the Calcanail provides anti-rotational geometry, which is vital for healing.

Thomas S. Roukis, DPM, PhD, has extensive experience using the Calcanail system and cites positive findings from clinical studies.

“Cadaveric and prospective non-randomized clinical studies have demonstrated that the Calcanail can reliably restore calcaneal morphology and achieve near anatomic reduction of the calcaneal posterior facet fragments through indirect, intraosseous manipulation of the articular fragments and rigid internal fixation contained within the calcaneus,” says Dr. Roukis, a Fellow and Past President of the American College of Foot and Ankle Surgeons.

Calcanail is the only device of its type cleared for use in the United States and, in Dr. Roukis’ opinion, comparable devices on the market can be problematic.

“The Vira calcaneal system (Biomet Spain Orthopaedics) requires arthrodesis of the subtalar joint at the time of fracture fixation and the C-Nail (Medin) is a very complicated system that requires a sinus tarsi surgical incision and screws across the posterior facet fragments separate from the transfixion screws in the nail itself,” notes Dr. Roukis, who has disclosed that he is a consultant for FH Ortho. Dr. Roukis says the fact that Calcanail’s entire surgical system is contained within one clearly labeled tray makes its use very straightforward.

Dr. LaPorta has achieved positive results using the Calcanail.

“To date, anatomic reductions have been comparable to open reduction in restoration of length and height of the calcaneus, reduction of lateral wall blowout and reduction of articular fragments,” says Dr. LaPorta. “The striking difference is the lack of soft tissue complications, edema and postoperative pain. Additionally, we have been able to allow protected partial weightbearing at the six to seven-week point.”

Additional benefits that Dr. Roukis has observed include rapid incision healing, an absence of nerve-related injuries and very rapid osseous fracture healing with maintenance of correction over time.

Ms. Garthwait is a freelance writer who lives in Downingtown, Pa.