Research progress in surgical treatment of calcaneal fracture malunions_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

JI Dongdong ¹ , WANG Qiong ² ,  ZHAO Hongmou ²

1. Xi’an Medical University, Xi'an Shaanxi, 710068, P. R. China;
2. Ankle Trauma and Degeneration Ward, Honghui Hospital of Xi’an Jiaotong University, Xi'an Shaanxi, 710018, P. R. China;

Corresponding?author：

ZHAO Hongmou, Email: zhao_hongmou@hotmail.com

Keywords：

Calcaneal fracture malunion; imaging findings; conservative treatment; surgical treatment

DOI：

10.7507/1002-1892.202509039

Video：

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Objective To review the pathological characteristics of calcaneal fracture malunions and the research progress of surgical treatment, so as to provide a reference for standardized clinical diagnosis and treatment. Methods The relevant research literature on calcaneal fracture malunions at home and abroad in recent years was reviewed. And the pathological characteristics, imaging manifestations, classification and the latest surgical treatment strategies of calcaneal fracture malunions were systematically expounded. Results Malunion may ensue after calcaneal fractures if conservative treatment fails or surgical intervention is improperly performed, leading to abnormal foot biomechanics and severe functional impairment. Typical pathological changes include three-dimensional morphological disorders of the calcaneus (abnormal width, height loss, and varus-valgus deformity), collapse of the subtalar articular surface accompanied by joint mismatch, secondary joint degeneration, Achilles tendon contracture, and lateral soft tissue impingement syndrome. Given the complex pathological anatomy after malunion, surgical plans should be individually tailored. The clinically used Stephens-Sanders classification and Zwipp-Rammelt classification provide a reliable basis for the accurate selection of treatment modalities. Staged treatments such as subtalar arthrodesis, osteotomy correction, and soft tissue release can effectively improve ankle and foot function. Conclusion In recent years, the biomechanical mechanisms, imaging evaluation systems, and reconstructive surgical strategies of calcaneal fracture malunion have become research hotspots. The selection of treatment plans should take into account specific clinical symptoms and morphological changes of the calcaneus, which is crucial for subsequent recovery. In the future, it is necessary to focus on individual differences, promote the integration of diagnosis and treatment, establish evidence-based guidelines, and achieve accurate and long-term deformity correction and functional reconstruction.

1.	李平, 張揮武, 張宇, 等. 保留距下關節的跟骨V形截骨矯形術治療陳舊性跟骨骨折. 中國骨傷, 2019, 32(10): 947-51.
2.	Bai W, Zhu Y, Xu J, et al. Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion: a retrospective study. J Orthop Surg Res, 2022, 17(1): 526. doi: 10.1186/s13018-022-03413-w.
3.	Ketz J, Clare M, Sanders R. Corrective osteotomies for malunited extra-articular calcaneal fractures. Foot Ankle Clin, 2016, 21(1): 135-45.
4.	Feng H, Ji DD, Yang XQ, et al. Three-plane calcaneal osteotomy with joint preservation vs subtalar arthrodesis to treat painful calcaneal fracture malunions. Foot Ankle Int, 2025, 46(3): 295-302.
5.	馬飛飛, 鄭凱夫, 陳金武, 等. 交鎖髓內釘內固定治療Sanders Ⅱ/Ⅲ型跟骨骨折療效分析. 創傷外科雜志, 2025, 27(02): 120-126,131.
6.	Stapleton JJ, Belczyk R, Zgonis T. Surgical treatment of calcaneal fracture malunions and posttraumatic deformities. Clin Podiatr Med Surg, 2009, 26(1): 79-90.
7.	Huang K, Guo Q, Zhu Y. The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases. Ann Palliat Med, 2021, 10(3): 3154-3161.
8.	Lee HS, Kim WJ, Park ES, et al. Mid-term follow-up results of calcaneal reconstruction for calcaneal malunion. BMC Musculoskelet Disord, 2019, 20(1): 43. doi: 10.1186/s12891-019-2419-1.
9.	Ebben BJ, Myerson M. Management of the subtalar joint following calcaneal fracture malunion. Foot Ankle Clin, 2022, 27(4): 787-803.
10.	陳城, 楊云峰. 跟骨骨折畸形愈合的研究進展. 中華醫學雜志, 2023, 103(37): 2978-2983.
11.	王雄, 強敏菲, 陳雁西. 跟骨骨折畸形愈合的治療現狀及進展. 足踝外科電子雜志, 2018, 5(3): 52-55.
12.	梁軍, 胡濱成. 跟骨的形態結構特點及其臨床意義. 中國臨床解剖學雜志, 2000, 16(2): 118-120.
13.	尹志平, 葉樹強, 羅濤, 等. 螺旋CT三維重建在跟骨骨折中的應用價值. 影像研究與醫學應用, 2022, 6(5): 89-91.
14.	李忠敏, 葉龍暉, 廖文彬. 螺旋CT三維重建術在跟骨骨折治療中的應用價值觀察. 黑龍江中醫藥, 2022, 51(5): 128-130.
15.	鹿亮, 羅文強, 李寧, 等. 跟骨骨折畸形愈合的治療進展. 實用醫院臨床雜志, 2024, 21(3): 10-13.
16.	劉紅旗, 楊雅琴, 楊秀珍. 醫學影像檢查對跟骨骨折的分型及治療意義. 中外醫學研究, 2017, 15(22): 60-61.
17.	Stephens HM, Sanders R. Calcaneal malunions: results of a prognostic computed tomography classification system. Foot Ankle Int, 1996, 17(7): 395-401.
18.	Rammelt S, Zwipp H. Corrective arthrodeses and osteotomies for post-traumatic hindfoot malalignment: indications, techniques, results. Int Orthop, 2013, 37(9): 1707-1717.
19.	Yu GR, Zhang MZ, Yang YF. Corrective osteotomies for malunited tongue-type calcaneal fractures. Foot Ankle Clin, 2016, 21(1): 123-134.
20.	胡愛軍, 歐陽柳, 許巖, 等. 富含血小板血漿與玻璃酸鈉治療早期踝關節骨性關節炎療效對比. 中國藥師, 2020, 23(1): 94-96.
21.	藍惠平, 劉芳. 超聲波治療儀聯合抗阻訓練在膝骨關節炎患者中的應用效果. 醫療裝備, 2025, 38(4): 85-88.
22.	張琪. 中藥濕熱敷治療膝關節骨性關節炎臨床觀察. 實用中醫藥雜志, 2023, 39(10): 2052-2053.
23.	Atkins RM. The treatment of calcaneal malunion. Foot Ankle Clin, 2014, 19(3): 521-540.
24.	楊杰, 梁曉軍, 李毅, 等. 保留距下關節治療Stephens Ⅰ型跟骨骨折畸形愈合. 中國矯形外科雜志, 2020, 28(12): 1140-1142.
25.	趙剛, 王金輝, 蔣協遠. 跟骨骨折畸形愈合的治療近況. 國際骨科學雜志, 2003, 24(4): 233-234.
26.	田浩棟, 劉亮, 胡東, 等. 滑行截骨聯合距下關節融合術治療嚴重跟骨骨折畸形愈合. 生物骨科材料與臨床研究, 2024, 21(4): 36-39.
27.	Dwyer FC. The present status of the problem of pes cavus. Clin Orthop Relat Res, 1975(106): 254-275.
28.	Barg A, H?rterer H, Jacxsens M, et al. Dwyer osteotomy: Lateral sliding osteotomy of calcaneus. Oper Orthop Traumatol, 2015, 27(4): 283-297.
29.	田浩棟, 劉承義, 丁楠, 等. 截骨矯形術治療跟骨骨折畸形愈合的研究進展. 足踝外科電子雜志, 2022, 9(3): 99-105.
30.	陸定松, 李鵬, 楊志奎, 等. 跟骨V形截骨保關節治療陳舊跟骨骨折. 臨床骨科雜志, 2022, 25(5): 741-744.
31.	Myerson M, Quill GE. Late complications of fractures of the calcaneus. J Bone Joint Surg (Am), 1993, 75(3): 331-341.
32.	Fletcher AN, Liles JL, Steele JJ, et al. Systematic review of subtalar distraction arthrodesis for the treatment of subtalar arthritis. Foot Ankle Int, 2020, 41(4): 437-448.
33.	賴良鵬, 孫寧, 武勇. 跟骨骨折后距下關節炎原位融合術的患者滿意度影響因素分析. 中華骨與關節外科雜志, 2024, 17(2): 143-148.
34.	Banerjee R, Saltzman C, Anderson RB, et al. Management of calcaneal malunion. J Am Acad Orthop Surg, 2011, 19(1): 27-36.
35.	唐金爍, 劉恩渤, 李陽, 等. 距下關節創傷性關節炎的研究進展. 足踝外科電子雜志, 2022, 9(2): 119-124.
36.	Oshba H, Shaaban RHA, Abdelrahman I, et al. Arthroscopic subtalar joint arthrodesis: topical review. Foot Ankle Int, 2022, 43(1): 131-145.
37.	Fradet J, Lopes R. Subtalar and talonavicular arthrodesis under lateral arthroscopy. Orthop Traumatol Surg Res, 2023, 109(1): 103439. doi: 10.1016/j.otsr.2022.103439.
38.	Shibuya N, Simmons A, Felix F. Posterior arthroscopic subtalar joint arthrodesis (PASTA). Clin Podiatr Med Surg, 2023, 40(3): 471-481.

1. 李平, 張揮武, 張宇, 等. 保留距下關節的跟骨V形截骨矯形術治療陳舊性跟骨骨折. 中國骨傷, 2019, 32(10): 947-51.
2. Bai W, Zhu Y, Xu J, et al. Y-shape osteotomy combined with subtalar arthrodesis for calcaneus malunion: a retrospective study. J Orthop Surg Res, 2022, 17(1): 526. doi: 10.1186/s13018-022-03413-w.
3. Ketz J, Clare M, Sanders R. Corrective osteotomies for malunited extra-articular calcaneal fractures. Foot Ankle Clin, 2016, 21(1): 135-45.
4. Feng H, Ji DD, Yang XQ, et al. Three-plane calcaneal osteotomy with joint preservation vs subtalar arthrodesis to treat painful calcaneal fracture malunions. Foot Ankle Int, 2025, 46(3): 295-302.
5. 馬飛飛, 鄭凱夫, 陳金武, 等. 交鎖髓內釘內固定治療Sanders Ⅱ/Ⅲ型跟骨骨折療效分析. 創傷外科雜志, 2025, 27(02): 120-126,131.
6. Stapleton JJ, Belczyk R, Zgonis T. Surgical treatment of calcaneal fracture malunions and posttraumatic deformities. Clin Podiatr Med Surg, 2009, 26(1): 79-90.
7. Huang K, Guo Q, Zhu Y. The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases. Ann Palliat Med, 2021, 10(3): 3154-3161.
8. Lee HS, Kim WJ, Park ES, et al. Mid-term follow-up results of calcaneal reconstruction for calcaneal malunion. BMC Musculoskelet Disord, 2019, 20(1): 43. doi: 10.1186/s12891-019-2419-1.
9. Ebben BJ, Myerson M. Management of the subtalar joint following calcaneal fracture malunion. Foot Ankle Clin, 2022, 27(4): 787-803.
10. 陳城, 楊云峰. 跟骨骨折畸形愈合的研究進展. 中華醫學雜志, 2023, 103(37): 2978-2983.
11. 王雄, 強敏菲, 陳雁西. 跟骨骨折畸形愈合的治療現狀及進展. 足踝外科電子雜志, 2018, 5(3): 52-55.
12. 梁軍, 胡濱成. 跟骨的形態結構特點及其臨床意義. 中國臨床解剖學雜志, 2000, 16(2): 118-120.
13. 尹志平, 葉樹強, 羅濤, 等. 螺旋CT三維重建在跟骨骨折中的應用價值. 影像研究與醫學應用, 2022, 6(5): 89-91.
14. 李忠敏, 葉龍暉, 廖文彬. 螺旋CT三維重建術在跟骨骨折治療中的應用價值觀察. 黑龍江中醫藥, 2022, 51(5): 128-130.
15. 鹿亮, 羅文強, 李寧, 等. 跟骨骨折畸形愈合的治療進展. 實用醫院臨床雜志, 2024, 21(3): 10-13.
16. 劉紅旗, 楊雅琴, 楊秀珍. 醫學影像檢查對跟骨骨折的分型及治療意義. 中外醫學研究, 2017, 15(22): 60-61.
17. Stephens HM, Sanders R. Calcaneal malunions: results of a prognostic computed tomography classification system. Foot Ankle Int, 1996, 17(7): 395-401.
18. Rammelt S, Zwipp H. Corrective arthrodeses and osteotomies for post-traumatic hindfoot malalignment: indications, techniques, results. Int Orthop, 2013, 37(9): 1707-1717.
19. Yu GR, Zhang MZ, Yang YF. Corrective osteotomies for malunited tongue-type calcaneal fractures. Foot Ankle Clin, 2016, 21(1): 123-134.
20. 胡愛軍, 歐陽柳, 許巖, 等. 富含血小板血漿與玻璃酸鈉治療早期踝關節骨性關節炎療效對比. 中國藥師, 2020, 23(1): 94-96.
21. 藍惠平, 劉芳. 超聲波治療儀聯合抗阻訓練在膝骨關節炎患者中的應用效果. 醫療裝備, 2025, 38(4): 85-88.
22. 張琪. 中藥濕熱敷治療膝關節骨性關節炎臨床觀察. 實用中醫藥雜志, 2023, 39(10): 2052-2053.
23. Atkins RM. The treatment of calcaneal malunion. Foot Ankle Clin, 2014, 19(3): 521-540.
24. 楊杰, 梁曉軍, 李毅, 等. 保留距下關節治療Stephens Ⅰ型跟骨骨折畸形愈合. 中國矯形外科雜志, 2020, 28(12): 1140-1142.
25. 趙剛, 王金輝, 蔣協遠. 跟骨骨折畸形愈合的治療近況. 國際骨科學雜志, 2003, 24(4): 233-234.
26. 田浩棟, 劉亮, 胡東, 等. 滑行截骨聯合距下關節融合術治療嚴重跟骨骨折畸形愈合. 生物骨科材料與臨床研究, 2024, 21(4): 36-39.
27. Dwyer FC. The present status of the problem of pes cavus. Clin Orthop Relat Res, 1975(106): 254-275.
28. Barg A, H?rterer H, Jacxsens M, et al. Dwyer osteotomy: Lateral sliding osteotomy of calcaneus. Oper Orthop Traumatol, 2015, 27(4): 283-297.
29. 田浩棟, 劉承義, 丁楠, 等. 截骨矯形術治療跟骨骨折畸形愈合的研究進展. 足踝外科電子雜志, 2022, 9(3): 99-105.
30. 陸定松, 李鵬, 楊志奎, 等. 跟骨V形截骨保關節治療陳舊跟骨骨折. 臨床骨科雜志, 2022, 25(5): 741-744.
31. Myerson M, Quill GE. Late complications of fractures of the calcaneus. J Bone Joint Surg (Am), 1993, 75(3): 331-341.
32. Fletcher AN, Liles JL, Steele JJ, et al. Systematic review of subtalar distraction arthrodesis for the treatment of subtalar arthritis. Foot Ankle Int, 2020, 41(4): 437-448.
33. 賴良鵬, 孫寧, 武勇. 跟骨骨折后距下關節炎原位融合術的患者滿意度影響因素分析. 中華骨與關節外科雜志, 2024, 17(2): 143-148.
34. Banerjee R, Saltzman C, Anderson RB, et al. Management of calcaneal malunion. J Am Acad Orthop Surg, 2011, 19(1): 27-36.
35. 唐金爍, 劉恩渤, 李陽, 等. 距下關節創傷性關節炎的研究進展. 足踝外科電子雜志, 2022, 9(2): 119-124.
36. Oshba H, Shaaban RHA, Abdelrahman I, et al. Arthroscopic subtalar joint arthrodesis: topical review. Foot Ankle Int, 2022, 43(1): 131-145.
37. Fradet J, Lopes R. Subtalar and talonavicular arthrodesis under lateral arthroscopy. Orthop Traumatol Surg Res, 2023, 109(1): 103439. doi: 10.1016/j.otsr.2022.103439.
38. Shibuya N, Simmons A, Felix F. Posterior arthroscopic subtalar joint arthrodesis (PASTA). Clin Podiatr Med Surg, 2023, 40(3): 471-481.

Chinese Journal of Reparative and Reconstructive Surgery

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