Historical and current treatment of calcaneal fractures.

Abstract

To The Editor: We congratulate Dr. Sanders on his excellent Current Concepts Review “Displaced Intra-Articular Fractures of the Calcaneus” (82-A: 225-50, Feb. 2000). Since this topic is of paramount interest and is still a matter of some debate, we would like to provide some information from the non-English-language literature. The historical review should mention the pioneering work of the French school in the 1920s, above all Leriche, who, dissatisfied with the results of closed treatment of calcaneal fractures, practiced open reduction and internal fixation with staples and screws1. The method of percutaneous leverage of the displaced tuberosity fragment and subsequent plaster immobilization of the pin was introduced as early as 1934 by the German surgeon Westhues2. We are well aware that the difficulties in the management of calcaneal fractures are reflected by a long historical record of different treatment options. However, the two above-mentioned procedures represent “milestones” that influenced and inspired surgeons like Palmer and Essex-Lopresti, who established the principles of modern treatment of calcaneal fractures. The computed-tomography-based classification by Zwipp and colleagues3, which was cited by Dr. Sanders, has proved to be of prognostic value when supplemented by an evaluation of soft-tissue damage and comminution on a 12-point scale. Bone fragments (maximum, five) and affected joint facets (maximum, three) are credited with 1 point each. Open or closed soft-tissue damage is scored on a 3-point scale. An additional point is assigned in case of extensive comminution of one major bone fragment or a fracture of another tarsal bone. With a predictive value of 86%, an excellent result can be expected with less than 7 points; a good result, with 7 or 8 points; a satisfactory result, with 9 to 10 points; and a poor result, with 11 or 12 points4. These …