From March 12, 2010, to August 17, 2017, 127 calcaneal malunions in 120 patients were surgically treated in our department. All patients with calcaneal fractures had been initially managed at other hospitals. The initial treatments included conservative treatments, which were performed on 38 feet with Sanders type I calcaneal fractures and 16 feet with Sanders type II fractures; surgical treatments of open reduction and internal fixation (ORIF), which were conducted on 36 feet with Sanders type II fractures and 19 with Sanders type III fractures; and subtalar joint fusion, which was performed on three feet with Sanders type III fractures and all Sanders type IV calcaneal fractures of 15 feet. Among them, patients with type I, II and III calcaneal malunions according to the Sanders calcaneal malunion classification were selected to receive a multiple reconstructive osteotomy with subtalar joint‐preserving operation. Beforehand, the articular cartilage of the calcaneal posterior facet was expected to be without or with mild osteoarthritis through preoperative radiographs, CT, and intraoperative visualization.
The inclusion criteria were as follows: (i) patients were definitely diagnosed with Sander I, II and III calcaneal malunions according to the Sanders calcaneal malunion classification; (ii) the period from the initial injury to reconstructive surgery was at least 4 months; (iii) the multiple reconstructive osteotomy, which comprised corrective osteotomies, joint realignment, soft tissue balancing, subtalar joint preservation and internal fixation, was performed as treatment; (iv) the pre‐ and postoperative medical data during the follow‐up period, including X‐ray, CT and physical examination, were complete and available; and (v) the follow‐up period was at least 2 years. Exclusion criteria included: (i) patients combined with other lower limb injuries; and (ii) patients were diagnosed with comorbidities, which might significantly affect the outcome evaluation (e.g., severe cardiopulmonary insufficiency and hepatic and renal dysfunction, multiple lower limb injury, etc.).
There were 10 patients (eight males, two females) with a mean age of 33.1 ± 7.45 years included in this study. Falling from height was the main cause of the injury, accounting for six of the 10 patients. In addition, two patients were injured from motor vehicle accidents, and falling from stairs and exercise injuries each caused one calcaneal fracture. Among these injuries, the initial fracture types of Sander I, II and III accounted for two, five and three fractures, respectively. Conservative treatment was initially given to all Sanders type I calcaneal fractures and two Sanders type II fractures, with others undergoing surgical treatment with ORIF. Correspondingly, there were two patients with Sanders type I, four patients with Sanders type II, and four with Sanders type III calcaneal malunion. All patients presented with pain in the hind foot or/and the inability to put full weight on the affected limb as their major complaints. Standard radiographs and CT were obtained preoperatively (Fig.1 ). All patients were treated with reconstructive surgery at a mean of 5.6 ± 2.41 months since the initial injury. The detailed information and characteristics of the included patients are illustrated in Table 1 .
The inclusion criteria were as follows: (i) patients were definitely diagnosed with Sander I, II and III calcaneal malunions according to the Sanders calcaneal malunion classification; (ii) the period from the initial injury to reconstructive surgery was at least 4 months; (iii) the multiple reconstructive osteotomy, which comprised corrective osteotomies, joint realignment, soft tissue balancing, subtalar joint preservation and internal fixation, was performed as treatment; (iv) the pre‐ and postoperative medical data during the follow‐up period, including X‐ray, CT and physical examination, were complete and available; and (v) the follow‐up period was at least 2 years. Exclusion criteria included: (i) patients combined with other lower limb injuries; and (ii) patients were diagnosed with comorbidities, which might significantly affect the outcome evaluation (e.g., severe cardiopulmonary insufficiency and hepatic and renal dysfunction, multiple lower limb injury, etc.).
There were 10 patients (eight males, two females) with a mean age of 33.1 ± 7.45 years included in this study. Falling from height was the main cause of the injury, accounting for six of the 10 patients. In addition, two patients were injured from motor vehicle accidents, and falling from stairs and exercise injuries each caused one calcaneal fracture. Among these injuries, the initial fracture types of Sander I, II and III accounted for two, five and three fractures, respectively. Conservative treatment was initially given to all Sanders type I calcaneal fractures and two Sanders type II fractures, with others undergoing surgical treatment with ORIF. Correspondingly, there were two patients with Sanders type I, four patients with Sanders type II, and four with Sanders type III calcaneal malunion. All patients presented with pain in the hind foot or/and the inability to put full weight on the affected limb as their major complaints. Standard radiographs and CT were obtained preoperatively (Fig.
