O1426 SURGICAL TREATMENT OF INTRA-ARTICULAR FRACTURES OF CALCANEUS

Abstract

Aims: The purpose of this study is comparative analysis of different surgical methods of calcaneal fractures treatment. Methods: From 1992 to 2001 we treated 132 patient (161 feet) with displaced intra-articular fractures of the calcaneus. All of these fractures have been classified according to the Essex-Lopresti Rx classification. 7 fractures were type A, 14 – type B1, 22 – type B2. Type C1 occurred in 51 cases, type C2- in 58 and type D – in 9 cases. 113 patients (134 feet) had fresh trauma (2–10 days after injury) and in 18 cases (27 feet) 3 up to 6 weeks passed from the moment of the injury. In 52 cases (62 feet) we used closed reduction and external fixation with Ilizarov apparatus. In other AO-implants were used: reconstruction 3,5 mm plate (19 cases), T-plate (12 cases), “Tampa plate”(59 feet) and new Locking Calcaneal Plate (9 feet). All patients underwent pre- and postoperative standard lateral and axial X-Ray and CT-scans. Follow-up results were analysed through 6 and 12 months. Results: Good and excellent results (no pain, no deformities and good function) were obtained in 74,2% patients, satisfactory results – in 18,2% of cases. In 7 patients the superficial skin necrosis was observed, in 5 cases deep wound infection developed. The best results are received in cases of Locking Calcaneal Plate application. Conclusions: Fractures of the calcaneus should be treated like other intra-articular fractures, i.e. careful reduction, stable fixation and early mobilization. Indirect reduction and external fixation can be applied only in A and B1-type of fractures. In fractures of B2 and C types good results can be obtained only by using stable osteosynthesis. In D-type fractures and neglected/delayed C2-fractures it is better to apply a primary sub-talar arthrodesis.