Surgical tips and tricks for open reduction and internal fixation of intra-articular calcaneal fractures

Twenty-four intra-articular calcaneal fractures in twenty-three patients have been treated by open reduction and internal fixation. Ten were women and thirteen were men. Age ranged from 18 to 45 years. Fracture classification was based on Sanders computed tomographic classification. There were 5 type II, 15 type III, and 4 type IV fractures. All operations were performed using a standard surgical technique with an extended lateral approach, and the fractures were fixed with plates and screws with bone grafting if needed. Average follow-up was 14 months [range, 10-22 months]. The Creighton-Nebraska assessment score was used for clinical evaluation. Radiological and functional assessments were done for all patients at the latest follow-up. Excellent results were achieved in nine fractures, good in twelve, and fair in three. The average score was 93 for type II, 89.2 for type III, and 73.75 for type IV fractures. There was a clear statistically significant superiority with type II and type III fractures treated with open reduction when compared with type IV fractures [p 0.0001]. Open reduction and internal fixation is recommended for all displaced intra-articular fractures of the calcaneus. It restores hindfoot and subtalar joint anatomy so that sub talar arthritis may be avoided