Surgical treatment of type IV Zwipp – Rammelt calcaneal fractures using customized resection templates

Introduction Calcaneal fractures account for approximately 2 % of all fractures and are common in younger population. Treatment of the patients can be challenging with involved articular and soft tissue component. Conventional methods can be ineffective for complex and rare type IV and type V Zwipp – Rammelt fractures necessitating development of new surgical approaches. The objective was to explore short-term (10 months of observation) outcomes of patients with type IV Zwipp – Rammelt calcaneal fractures using a new technology. The technique suggested improved accuracy of remodeling osteotomy due to three-dimensional reconstruction of the broken foot during preoperative planning and creation of customized resection templates with additive technologies. Material and methods A prospective, hypothesis-generating study was performed for 13 patients with type IV Zwipp – Rammelt calcaneal fractures. There were 6 males and 7 females with the mean age of 45.5 ± 13.02 years. The patients were treated with the new method which employed 3D reconstruction of the broken foot using MSCT images, fabrication of customized resection templates using FDM printing, their sterilization with ethylene oxide, precision osteotomy of the calcaneus through an L-shaped approach and subtalar arthrodesis. The results were assessed at 77 weeks using AOFAS, EFAS, FFI and VAS scales. Results Functional parameters significantly improved at ten months with the EFAS increased by 2.5 times (to 34.0 scores, p = 0.0002), AOFAS improved by 1.6 times (to 80.0 scores, p = 0.0002), FFI increased by 1.57 times (to 38.0 scores, p = 0.0002). Pain improved with the VAS decreasing by half from 60 mm to 30 mm (p = 0.001). Discussion The technique demonstrated several advantages with the possibility of multiplanar osteotomies, precise template fixation and control of resection parameters facilitating anatomical restoration. Conclusion Short-term outcomes of patients with type IV Zwipp – Rammelt calcaneal fractures showed that custom-made resection templates were practical for accurate surgical technology, improved functional outcomes, pain relief using the effective technique.