Operative treatment of calcaneal fractures

Abstract

Objective To investigate the injury mechanism, clinical classification, treatment methods and clinical results of calcaneal fractures. Methods From June 2005 to May 2009, 83 feet in 70 patients with calcaneal fractures were treated. According to Sanders and Essex-Lopresti classifications, 63 feet had intra-articular fractures (30 feet of type Ⅱ, 21 type Ⅲ, and 12 type Ⅳ ) and 20 feet had extra-articular fractures (3 feet of lateral condylar fracture, 5 anterior process fracture, 9 calcaneal body fracture and 3 nodules fracture) . Reduction with a conventional lateral L-incision, mini-incision, or leverage was conducted depending on the clinical classification of the fracture involved. Fixation with a conventional plate or locking plate, simple screws and Kirschner wire was applied in all patients. Bone grafting was performed in the 20 cases whose defects were larger than 2 cm3. Functions and complications of the feet were observed at the follow-up. Results The 70 patients were followed up from 12 to 30 months (average, 18 months). The total average American Orthopaedic Foot and Ankle Society(AOFAS) score was (90.3 ± 11.0) points (48 to 100 points). The average AOFAS score for the 20 feet of extra-articular calcaneal fracture was (98.1±2.6)points (90 to 100 points), with no complications; the average AOFAS score for the other 63 feet of intra-articular calcaneal fracture was (87.8 ± 11.4) points (48 to 100 points) with such complications as necrosis at the skin edge of incision in 2 feet, sural nerve injury in 4 and traumatic subtalar arthritis in 10.Conclusions Treatment of extra-articular calcaneal fractures may have better clinical results than treatment of intra-articular calcaneal fractures. The preoperative evaluation of the fracture type and severity of soft tissue injury is especially essential to the treatment. Key words: Calcaneus; Fractures; Fracture fixation, internal; Postoperative complications