TALAR PROCESS FRACTURES OF THE CALCANEUM: SIX-YEAR OUTCOME OF 80 FRACTURES TREATED BY TRIANGLE ASSEMBLY OF 1/4 TUBE PLATES

Abstract

Purpose: The purpose of this work was to evaluate clinical and radiological results of surgical treatment of 80 calcaneum fractures involving the posterior talar process using 1/4 tubes used for triangulation fixation.

Material and methods: The series involved 73 patients (seven bilateral fractures), 56 men and 17 women, average age 39.6 years (15–67) who were treated between 1990 and 1999. Patients were victims of 34 home accidents (46.6%), 19 sports accidents (26%), 14 occupational accidents (19.2%), and six traffic accidents (8.2%). The Duparc classification was: type 2 (n=2) type 3 (n=17), type 4 (n=51), and type 5 (n=10). Junior surgeons performed most of the procedures who used seven ‘inverted-V’ assemblies and 73 triangular assemblies. Forty-two patients (47 fractures) were reviewed (58.8% of fractures) clinically and radiologically to assess stability of the fixation (Boehler angle and talocalcaneal angle) and search for osteoarthritis.

Results: Mean follow-up was six years (1.5–11.5). There were few complications: four late healing (5%), five reflex dystrophy (6.3%) and two infections (2.5%) (Met-S Staphylococcus aureus and Bacterium bovis corineus. Subjectively, 93.5% of patients were satisfied or very satisfied. At last follow-up, the Boehler angle was 27.5±6.7°. The subtalar space was normal or nearly normal in 46.8% and narrowed or destroyed (osteoarthritis) in 53.2%. The Kitaoka function score (AOFAS) was 73.2 points on average with 44.7% excellent or good results and 44.8% fair results. The SOFCOT score was very good, good, or rather good in 63.8% and fair in 10.3%; it was also noted that among the 25.5% poor results, three patients required secondary subtalar arthrodesis. 86% of the patients resumed their occupational activities and 63% of the patients practicing sports resumed their activities.

Conclusion: Osteosynthesis of calcaneum fractures using 1/4 tubes used in a triangular configuration provides stable fixation (little secondary loss of Boehler angle) with a satisfactory cutaneous impact (few cases of skin necrosis). The subjective outcome is very satisfactory. Objective outcome may appear disappointing but is generally related to the severity of the fracture (76% types 4 and 5) or type of fixation configuration.