A technique of internal fixation for os calcis fractures

Abstract

Healing of the fracture in optimal position. Restoration of joint surfaces and function of the subtalar and calcaneocuboid joints. Os calcis fractures of type A2 and B2 of our classification modified after the AO classification published by Muller. Poor skin and soft tissue conditions. Severely comminuted fractures, osteoporosis. Peripheral circular disturbance. Uncooperative or inactive patients. Supine. Tourniquet. Operating table which can be tilted and is radiolucent. General, spinal or epidural anaesthesia. Closed reduction using an external fixator, introduced from the medial side into the calcaneal tuberosity and the first metatarsus. Open reduction of the joint surfaces with the possible use of autogeneous cancellous bone grafts and plate fixation laterally. Posterior plaster slab for the first postoperative days. Elevation of limb. Out of cast physiotherapy of the ankle and subtalar joints starting the first postoperative day. Partial weight bearing of 20 kg using 2 canes is permitted in reliable patients after wound healing. For the other patients partial weight bearing in the plaster slab. Full weight bearing after 8 to 10 weeks depending on radiologic state of consolidation. 37 os calcis fractures were thus treated between 1988 and 1991. Patient age varied between 7 and 74 years, mean age 38.9 years. 12% of the patients suffered of polytrauma. Average time to full weight bearing: 12 weeks. Follow-up of 32 patients after 15 to 64 months, mean 33 months: 24 patients returned to the same occupation, 3 patients retired, 2 patients changed their occupation and 3 are unemployed. Scoring according to the method proposed by Merle d'Aubigne. Fracture types and results are listed in Table 1. The following complications were observed: 6 haematomas needing evacuation. Injury to the dorsal cutaneous nerve in 6 patients, pain at the subtalar joint while walking over uneven ground in 22 patients, 3 patients wear orthopaedic shoes and 12 arch supports. Up to now no subtalar arthrodesis became necessary.