English

Abstract

INTRODUCTION: Calcaneum is the most frequently fractured tarsal bone. Historically intra articular calcaneum fractures treated non-operatively which led to increased morbidity due to in congruency of articular surface resulting in subtalar arthritis. With advent of CT scan, better implants and improved methods of fixation. Operative treatment has now become a standard method. AIM OF THE STUDY: To study the functional and radiological outcome of intra articular calcaneum fractures treated by open reduction and internal fixation using locking compression plate. MATERIALS AND METHODS: Fifteen patients with intra articular calcaneum fractures treated by open reduction and internal fixation using locking compression plate from May 2012 to September 2014 at Rajah Muthiah Medical College Hospital with follow up of 6months. The fractures were classified on the basis of computer tomography (CT) findings as Sanders type I to IV. The aim of our treatment is to achieve anatomical reconstruction of all articular surfaces, restore Bohler's and Gissane angles, to carry out primary stable fixation and begin early mobilization. The patients were evaluated by Modified Maryland Foot Score, with excellent defined as90 - 100 points, good as 75 - 89 points, fair as 50 - 74 points and poor as <50 points. RESULTS: Fourteen patients were male and only one female. Twelve patients sustained fractures due to fall from height, three patients due to RTA. The mean pre-operative Bohler's angle was 13 degree and mean post-operative angle was 26.2degree. The mean pre-operative Gissane angle was 147.6 degree and the mean post-operative angle was 121 degree. Excellent modified Maryland Foot score were achieved in 9 patients, good in 3, fair in 1patient.Only 2 had poor outcome. CONCLUSION: Surgical treatment of intra-articular calcaneum fractures using locking compression plate by lateral approach has good functional outcome. CT scan is required for understanding the geometry of fractures and to assess subtalar disruption. Good timing of surgery is of paramount importance to avoid early complications. Reconstruction of subtalar anatomy prevents subtalar arthritis & maintains the foot biomechanics.