Ali Yüce - Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
Abdulhamit Mısır - Department of Orthopedic and Traumatology, Medicana International Istanbul Hospital, Istanbul, Turkey
Bülent Karslıoğlu - Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
MUSTAFA YERLİ - Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Istanbul, TURKEY
Mustafa Yerli - Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
Yunus Imren - Department of Orthopedic and Traumatology, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey

Background: The calcaneofibular ligament is cut to increase vision in surgical field in minimally invasive surgery of displaced intraarticular calcaneus fractures with subtalar incision. We aimed to investigate whether this causes talar tilt instability in ankle stress radiographs due to the calcaneofibular ligament deficiency in postoperative period.Methods: The files of ۳۸ patients who were operated with the diagnosis of displaced calcaneus fracture between ۲۰۱۳ and ۲۰۱۸ were examined retrospectively. All the cases underwent with subtalar approach and the calcaneofibular ligament was repaired after the operation. The age, sex, injury mechanism, follow-up length, type of fracture by the Sanders classification, preoperative and postoperative Bohler’s and Gissane’s angle measurements, talar tilt measurements of intact and fractured side, postoperative calcaneal length, calcaneal height and calcaneal width of the cases were recorded. The obtained data were evaluated statistically. Results: ۳۱ (۸۱.۶%) of the cases were men, seven (۱۸.۴%) were women. The average age was ۳۱.۹۲±۷.۹۵ years. The average follow-up time was ۱۵.۸۲±۳.۳۳ months. The preoperative Bohler’s angle was ۱۴.۱۶±۳.۶۷ degree, while the postoperative Bohler’s angle was ۳۱.۵۳±۴.۶۰ degree (P<۰.۰۵). The average talar tilt was ۰.۹۶±۰.۸۷ degrees on the intact side and ۱.۱۹±۱.۱۲ degrees on the fractured side (P:۰.۰۰۱). Although the talar tilt values were statistically higher on the fractured side than the intact side, no radiological instability finding was found in any case. The average postoperative Gissane’s angles were ۱۲۶.۴۵±۶.۶۹ degrees. The calcaneal length (P:۰.۶۶۵), calcaneal width (P:۰.۲۱۲) and calcaneal height (P:۰.۳۴۱) were statistically similar between the postoperative fractured foot and intact foot.Conclusion: Sectioning of the calcaneofibular ligament in the surgical treatment with subtalar approach does not cause lateral ankle instability in stress radiographs but may cause laxity. Possible postoperative lateral ankle injuries can be prevented by ankle proprioception exercises.Level of evidence: III

ankle instability, calcaneal fracture, calcaneofibular ligament, sinus tarsi approach, subtalar approach