Minimal invasive mini-rail external fixation for surgical treatment of calcaneal fractures


  • Mario Cala, DPM Fellowship Trained Attending Physician, Faculty, Mercy Hospital, Miami, FL
  • Melissa Perurena, DPM Attending Physician, Mercy Hospital, Miami, FL
  • Sidharath Jhanji, DPM Fellow, Fellowship in Podiatric Sports Medicine- Barry University, Mercy Hospital, Miami, FL
  • Edgar Sy, DPM Chief Podiatry Resident Physician, Jackson North Medical Center, North Miami, FL



calcaneal, fracture, minirail, external fixation, calcaneus, MIS, minimally invasive, monorail


The purpose of this study is to evaluate and promote the application of percutaneous minimal invasive uniplanar mini-rail external fixation for definitive fixation for displaced calcaneal fractures. This technique has been promoted to avoid soft tissue complications commonly seen with calcaneal open reduction internal fixation, and allows to apply skeletal traction and fracture reduction through ligamentotaxis with percutaneous fixation of the posterior facet fragments without the need to delay surgery secondary to edema. ​In this retrospective study, application of four 3.0mm stainless steel partially threaded half pins were applied across an intra-articular calcaneal fracture, 2 proximal and two distal, allowing for longitudinal traction and stabilization following reduction. Clinical outcomes were determined with a minimal 12-month follow up and a American Orthopedic Foot and Ankle Score (AOFAS) hindfoot score questionnaire. We evaluated and surgically managed 21 patients who presented to the emergency department with closed calcaneal fractures in a 6-year period, beginning from the year 2014 to 2020 with mini-rail fixation. Of the 21 patients, 12 (57%) participated in this study and were also evaluated by physical examination. Regarding patient satisfaction with minimal invasive percutaneous mini-rail fixation, patients reported an average AOFAS score of 82.1, 91% (11/12 patients) and were able to return to work, and only 1 patient required an additional surgery. The clinical results are comparable with traditional open reduction internal fixation with no soft tissue disruption, avoidance of internal fixation plates/screws, and allows for early mobilization.


Forgon, M. "Closed reduction and percutaneous osteosynthesis: technique and results in 265 calcaneal fractures." Major fractures of the pilon, the talus, and the calcaneus. Springer, Berlin, Heidelberg, 1993. 207-213.

Zgonis T, Roukis TS, Polyzois VD. The use of Ilizarov technique and other types of external fixation for the treatment of intra-articular calcaneal fractures. Clin Podiatr Med Surg. 2006 Apr;23(2):343-53, vi-vii. doi: 10.1016/j.cpm.2006.01.011. PMID: 16903157.

Agren PH, Mukka S, Tullberg T, Wretenberg P, Sayed-Noor AS. Factors affecting long-term treatment results of displaced intraarticular calcaneal fractures: a post hoc analysis of a prospective, randomized, controlled multicenter trial. J Orthop Trauma. 2014 Oct;28(10):564-8. doi: 10.1097/BOT.0000000000000149. PMID: 24824095.

Rammelt S, Zwipp H. Calcaneus fractures: facts, controversies and recent developments. Injury. 2004 May;35(5):443-61. doi: 10.1016/j.injury.2003.10.006. PMID: 15081321.

Letournel E. Open treatment of acute calcaneal fractures. Clin Orthop Relat Res. 1993 May;(290):60-7. PMID: 8472472.

Banks AS, DOwney, MS, Martin DE. McGlamry’s Comprehensive Textbook of Foot and Ankle Surgery, Lippincott Williams & Wilkins • 2001 • ISBN-10: 0683304712. ISBN-13: 978-0683304718. Foot & Ankle Specialist. 2009;2(4):200-200.

Dayton P, Feilmeier M, Hensley NL. Technique for minimally invasive reduction of calcaneal fractures using small bilateral external fixation. J Foot Ankle Surg. 2014 May-Jun;53(3):376-82. doi: 10.1053/j.jfas.2014.01.017. Epub 2014 Mar 5. PMID: 24618247.

DeCarbo WT, Hyer CF. Negative-pressure wound therapy applied to high-risk surgical incisions. J Foot Ankle Surg. 2010 May-Jun;49(3):299-300. doi: 10.1053/j.jfas.2010.01.002. PMID: 20605565.

Rammelt S, Amlang M, Barthel S, Zwipp H. Minimally-invasive treatment of calcaneal fractures. Injury. 2004 Sep;35 Suppl 2:SB55-63. doi: 10.1016/j.injury.2004.07.012. PMID: 15315879.

Schuberth JM, Cobb MD, Talarico RH. Minimally invasive arthroscopic-assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases. J Foot Ankle Surg. 2009 May-Jun;48(3):315-22. doi: 10.1053/j.jfas.2009.01.002. Epub 2009 Apr 2. PMID: 19423031.

Shaar, Camille Meleek, and Frank Peter Krenz. Manual of Fractures: Treatment by External Skeletal Fixation. WB Saunders Company, 1943.

Stapleton JJ, Kolodenker G, Zgonis T. Internal and external fixation approaches to the surgical management of calcaneal fractures. Clin Podiatr Med Surg. 2010 Jul;27(3):381-92. doi: 10.1016/j.cpm.2010.03.003. Epub 2010 May 14. PMID: 20691371.

Nosewicz T, Knupp M, Barg A, Maas M, Bolliger L, Goslings JC, Hintermann B. Mini-open sinus tarsi approach with percutaneous screw fixation of displaced calcaneal fractures: a prospective computed tomography-based study. Foot Ankle Int. 2012 Nov;33(11):925-33. doi: 10.3113/FAI.2012.0925. PMID: 23131437.

McGarvey WC, Burris MW, Clanton TO, Melissinos EG. Calcaneal fractures: indirect reduction and external fixation. Foot Ankle Int. 2006 Jul;27(7):494-9. doi: 10.1177/107110070602700703. PMID: 16842715.

Bosacco SJ, Berman AT, Connolly TC. "Treatment of calcaneal fractures with carbon fiber external fixation." meeting of the American Academy of Orthopaedic Surgeons. San Francisco. 1990.

Aşik M, Sen C. Surgical management of intraarticular fractures of the calcaneus. Arch Orthop Trauma Surg. 2002 Jul;122(6):354-9. doi: 10.1007/s00402-002-0407-6. Epub 2002 Apr 16. PMID: 12136302.




How to Cite

Cala M, Perurena M, Jhanji S, Sy EF. Minimal invasive mini-rail external fixation for surgical treatment of calcaneal fractures. J Int Foot Ankle [Internet]. 2022 May 1 [cited 2022 Jul. 7];1(5). Available from: