Application of poly-axial calcaneal locking plate for Sanders type IV intra-articular calcaneal fractures

Abstract

Objective To investigate the technique and clinical outcome of a polyaxial locking plate for treatment of Sanders IV intra-articular calcaneal fractures. Methods From January 2012 to July 2014, 17 cases of Sanders IV intra-articular calcaneal fractures were treated in our department. There were 14 males and 3 females with a mean age of 34.7 year-old (range, 18-49 years). Routine radiographic examination including X-ray and CT scanning was taken pre-operatively. Not until was the soft tissue condition improved, an open reduction and internal fixation with poly-axial locking plate would be performed. Regular X-ray was taken for measurement of the Bohler’s angle during the follow-up. Overall functional evaluation was carried out according to visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. Complications were also recorded. Results All wounds were healed at the primary stage with no soft tissue complications of infection or skin necrosis. 13 patients had been followed-up for 12 to 36 months, with an average of 24 months. The X-ray found the bone union at an average time of 12 weeks (range, 9-16 weeks). The average Bohler's angle was improved from 12.0°±4.2° (range, 5°-20°) preoperatively to 33.2°±4.6° (range, 26°-42°) postoperatively. The mean AOFAS ankle and hindfoot score at the latest follow-up was 82.2±5.4 (range, 70-90). The mean score of VAS was 1.2±1.0 (range, 0-3). 4 patients suffered from subtalar posttraumatic arthritis with a mild pain when walking for a long distance, which could be relieved by NSAIDs. Conclusion Treatment of Sanders IV intra-articular calcaneal fractures with a poly-axial locking plate could obtain a stable fixation and an acceptable clinical outcome, which is a safe and effective method. Key words: Calcaneus; Fractures, bone; Internal fixators; Fracture fixation, internal