SURGICAL TREATMENT OF INTRAARTICULAR CALCANEAL FRACTURES

Abstract

Introduction and purpose: Calcaneal fractures account for approximately 2% of all fractures. The calcaneus is the ankle bone that is most frequently fractured. Historically, calcaneal fractures have had a poor prognosis, with sequelae of more or less tolerable pain, flat foot, and different degrees of disability, and can end up with a subsequent subtalar fusion. Most of these fractures occur in the workplace, in men between 40–50 years of age. They are caused by falls from significant heights, and are therefore associated with other fractures such as spinal fractures. A therapeutic guide is applied for the indication of surgery in intrathalamic calcaneal fractures.

Materials and methods: Using Sanders’ classification based on diagnosis by CT that differentiates articular fractures from intrathalamic or extraarticular fractures, 47 patients underwent surgery with open reduction and internal fixation with an SPS plate, most of them by a lateral approach, between 1999 and 2006. The patients were all men with a mean age of 34.8 years with intraarticular calcaneal fracture types II and III according to the Sanders’ classification.

Results: Intraarticular fractures with displacement accounted for 70.75% of all calcaneal fractures. Our working-age patients, treated surgically, were assessed according to management criteria, medical criteria, scientific criteria and patient-related criteria; total disability due to sequelae has decreased by 75%. Return to former working activities was achieved in 60% of cases. Results were good in 54%, fair in 22%, poor in 23% of cases; surgeon satisfaction was high in 70% of cases and patient satisfaction was excellent to good in 70% of cases. The complications seen were: suture dehiscence, superficial and deep infections and sural nerve dysesthesia.

Conclusions: We used CT to diagnose intraarticular fractures and Sanders’ Classification to establish the indication for surgery. Since the establishment of a therapeutic guide for the indication of surgery using an open reduction and internal fixation technique, we have achieved 55% of good results, total disability has decreased by 75%, and we have achieved return to previous work in 60% of the patients. Morbidity due to sequelae has decreased; these sequelae were previously accepted as something to be expected from the moment of fracture with orthopedic treatment.