Abstract
The best treatment for intra-articular fractures of the calcaneus is still debated. The aims of this study were to determine whether intrafocal reduction of thalamic fractures is effective, to evaluate whether a locking nail is able to maintain reduction of the articular surface and to analyse the functional results of this original method. This prospective study assessed 69 fractures treated with a locking fracture nail in 63 cases and with primary subtalar fusion in six (Calcanail (®), FH). Articular congruity and global reduction of the calcaneus was assessed in all patients by computed tomography (CT) scan three months postoperatively. Functional results were evaluated according to the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AHS) and all complications recorded. For the 63 fracture nails, the average AOFAS score was 85.9 at a mean final follow-up of 12 months. Only three secondary fusions were performed. For the six comminuted fractures requiring primary fusion, the average AOFAS score was 75.9 at the last follow-up. The posterior intrafocal approach for both reduction and locked nailing of intra-articular calcaneal fractures has been proven as an effective and reliable procedure.
Highlights
There is insufficient evidence that surgical treatment is more effective than conservative treatment in displaced intra-articular calcaneal fractures (DIACFs) [1,2,3]
As with all other articular fractures, DIACFs should be treated by anatomic reduction, internal fixation and early mobilisation; the global shape of the calcaneal body, i.e. height, width and length, should be restored to provide the best possible walking capacities
We developed a technique five years ago to perform an intrafocal reduction through a channel created in the calcaneal tuberosity and—more recently—the use of an intramedullary locking nail to provide stable fixation of the reduced fracture [14]
Summary
There is insufficient evidence that surgical treatment is more effective than conservative treatment in displaced intra-articular calcaneal fractures (DIACFs) [1,2,3]. As with all other articular fractures, DIACFs should be treated by anatomic reduction, internal fixation and early mobilisation; the global shape of the calcaneal body, i.e. height, width and length, should be restored to provide the best possible walking capacities. Alternative procedures have been proposed, including two-stage procedures [5, 6], minimally invasive techniques [7,8,9,10], balloon reduction and cement fixation [11, 12] and even a tailormade treatment strategy [13]. Most minimally invasive techniques achieve reduced primary stability and reduction accuracy is difficult to verify even with arthroscopy or 3D fluoroscopy
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