Complications of dislocated calcaneal fractures.

BACKGROUND: Calcaneal fractures are the most common of all tarsal fractures, with the majority being the result of high energy injuries causing comminution of bone and lesions of the posterior articular surface. If the bone fragments are left dislocated or non-operative reduction is attempted, the outcome is poor, often with chronic disability. On the other hand, operative treatment does not always lead to a good result and there is an inherent risk of devastating complications. MATERIAL AND METHODS: During a 3-year period (2002-2005) the authors treated operatively (by open reduction and internal fixation) 23 dislocated calcaneal fractures involving the posterior calcaneotalar joint. A control group of 12 patients was treated non-operatively or using minimally invasive techniques. Medium-term results were compared by evaluating the Bohler and Gissane angles and the shape of the posterior calcaneal articular surface on radiographs (lateral and Broden views), while functional outcomes were rated according to the Creighton-Nebraska scale. Complications not included into this scheme were noted. RESULTS: Both anatomic and functional results were markedly better in the group treated with open reduction and internal fixation. In this group, there were three cases of infectious complications that were attributed to the surgical procedure, while in the other group, two such cases were associated with open fractures. Both groups developed clawing of the toes. The quality of reduction was always unsatisfactory in the non-operative group. CONCLUSIONS: 1. Complications of calcaneal fractures significantly worsen the therapeutic outcome. 2. Proper care based on meticulous evaluation of the foot in the early period is crucial for reducing the incidence of complications.

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.