Minimally Invasive Treatment for Nonunion in an Unusual Pattern of Neuropathic Calcaneal Fracture: A Case Report.

Neuropathic arthropathy is the painless destruction of weight-bearing bones and joints that is caused by a neurosensory deficit. Minimally displaced neuropathic fractures may be managed non-operatively. However, larger displacements often require surgical fixation. Nonunion is a rare entity in calcaneal fractures, and its occurrence in a neuropathic setting is an even rarer scenario. An unusual clinical scenario means there is a paucity of literature to guide the optimum treatment. Here we describe a patient with neuropathic arthropathy due to meningomyelocele in childhood, presenting with neuropathic nonunion of the calcaneum, managed with a minimally invasive surgical approach using an arthroscopic burr and fixation with percutaneous screws. Despite the high risk of complications in the operative treatment of neuropathic fractures, good functional results and successful limb salvage may be achieved with minimally invasive techniques.