Abstract
Background: There no consensus as to which is the best treatment for intra-articular fractures of the calcaneus. However, operative treatment of displaced intra-articular calcaneal fractures has become more accepted in the last ten to fifteen years, as a result of improvements in preoperative evaluation, the use of intraoperative imaging to verify the quality of the reduction, and advancements in surgical techniques and implants. Despite of these, still surgical treatment of intra-articular fractures of calcaneus continue to pose challenge to orthopedic surgeons .Objective: The purpose of this study is to evaluate the result of open reduction and internal fixation of displaced intra-articular calcaneal fractures. Design: A prospective study. Material and Methods :Twenty five displaced intra-articular calcaneal fractures in 24 patients ,were treated by open reduction and internal fixation from 2003 to 2006 .There were 21 males and three females . Sixteen fractures on right and nine on the left .The average age of the patients was 32 years ranged (21-43 years). The fractures were classified according to Sander's classification as follow ,type II 8 fractures(32%), type III 14 fractures (56%), and type IV 3fractures (12%). All the fractures were operated using a standard surgical technique ,through an extended lateral approach , the fractures were reduced and internally fixed with specific plates (small T plate in 4 fractures, 3.5 reconstruction plate in 6 fractures , and calcaneal AO plate in 15 fractures ) and screws (3.5 mm cortical, and 4 mm cancellous ). Bone graft was used in 13 fractures. The average follow-up was 18 months ranged (13-36 months). The Creighton-Nebraska assessment score was used to evaluate the clinical results also, the radiographic examination and CT scan that were done during follow-up were used to evaluate the radiological results. Results : The clinical results were excellent in 10 fractures (40%) , good in 11 fractures(44%),fair in 3fractures (12%) , and poor in one fracture (4%) .The average score in type II fractures was 91 points ,in type III was 80 points and in type IV was 71.3 points .All the fractures united at a mean 10 months . The Bohler's angle and Gissane's angle were reduced to nearly close to normal value . The average postoperative value for Buhler's angle was 31 degrees and for Tisane's angle was 135 degrees .The articular surface of the posterior facet was reduced and congruent in 16 fractures (64%), step-off less than 2mm in 8 fractures (32%) , and step-off more than 2mm in one fracture (4%) .The calcaneal length was reduced to normal value in all fractures . Only three fractures had slight loss of the calcaneal height. There was mild residual varus and slight increase in the width of the calcaneus in three fractures. Conclusions: Open reduction and internal fixation can be achieve satisfactory results for displaced intra-articular fractures of the calcaneus specially in Sanders type II and type III fractures .However, in Sanders type IV fractures open reduction and internal fixation should be attempted first to restore the calcaneal anatomy and congruity of subtatar joint . The procedure of open reduction and internal fixation for displaced intra-articular fracture of the calcaneus is surgically demanding, and an ascending learning curve is needed to achieve more satisfactory results.
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