Surgical treatment of articular calcaneal fractures.

BACKGROUND: Although Leriche (in 1921) and Judet (in 1954) introduced screw or plate fixation of the broken calcaneus, surgical treatment using open anatomical reduction and stable internal osteosynthesis only appeared in the early 1980s. This was made possible by the introduction of imaging methods such as CT, which allowed for better detection of the fracture pathology and provided the basis for new surgical strategies, e.g. anatomically-shaped calcaneal plates, available since the early 1990s.

MATERIAL AND METHODS: During a 3-year period (2002-2005) the authors operated 23 dislocated calcaneal fractures (19 men, 4 women, 19-57 years of age) involving the posterior calcaneo-talar joint (Sanders II and III according to CT-based classification). Treatment involved open reduction and internal fixation of the calcaneus through an extended lateral approach. Fixation was performed using lag screws and a reconstruction plate. We describe both the anatomic results (evaluation of the posterior articular surface of the calcaneus and the Bohler angle) and the functional outcome, using the Creighton-Nebraska system.

RESULTS: In this prospectively evaluated group we achieved 12 good and 11 very good anatomical results, and 2 fair, 16 good and 5 very good functional outcomes at follow-up (at least one year after surgery). Infections occurred in 3 cases.

CONCLUSIONS: The treatment option described here requires careful preoperative planning, with evaluation of the fracture pattern and patient condition, and good surgical expertise, but it provides good medium-term (1-3 years) outcome. The presence ofa good or very good reduction does not always correlate with the functional outcome.