Treatment of intra-articular fractures of Os calcis with open reduction, internal fixation and bone graft

Abstract

Surgical Principles The subtalar joint is a major weight bearing joint in the lower limb. Displaced intra-articular fractures of the os calcis should be treated with anatomical reduction and stable internal fixation to allow early mobilization. Intra-articular fractures of the os calcis lead to loss of joint congruity, and impaction of the cancellous bone. Bone grafting, together with stable internal fixation, allow early mobilization and weight bearing after surgery. The operation is done with the lateral approach which allows direct access to the fracture site. The subchondral bone, the sustentaculum tali and the medio-inferior part of the os calcis provide good bone stock for the purchase of screws. After reduction and fixation of the depressed fragments, the space is filled with cortico-cancellous grafts. The lateral wall of the os calcis is buttressed with a plate. Postoperatively, passive mobilization is started early, walking with a weight relieving calliper lasts for the first six weeks and graduated weight bearing is started on the seventh week.