ARE INTERNAL FIXATION LIMITS OF COMPLEX CALCANEAL FRACTURES WITH LOCKED SCREWS CALCANEAL PLATES DRIVEN BACK? LONG TERM RESULTS ABOUT 35 CASES

Abstract

Aims: Internal Fixation of complex calcaneal articular fractures is debated: a perfect and upheld reduction is challenging. Could locked screws calcaneal plates drive back the limits of Internal Fixation instead of initial arthrodesis, involve a faster rehabilitation and improve the results?

Methods: Between 2004 and 2008, 32 patients (26 men, 6 women), sustained 35 complex calcaneal articular fractures. Age: 41.46 [17–71] ±15.99 years. Pre operative TDM: ≥3 displaced articular fragments (Sanders III: 22 and IV: 13). ORIF by the same surgeon, between D4 and D7, through a lateral approach and using an AO LCP^® locked screws calcaneal plate. Intra operative X-ray controls, postoperative TDM. Articular re-education at D30. Complete weight bearing at D90. Follow-up until 60 months (X-ray and Kitaoka score).

Results: Obtained and upheld anatomical articular reduction -Boehler’s angle, talo and cubo-calcaneal congruence-: (35/35). Bone healing: 8 weeks (21/35) and 12 weeks (14/35). Delayed wound healing -smokers-: (6/35). Anatomical articular upholding after 12 months: (35/35). Plate ruptures at D90 without displacement: (2/35). Walking without crutch after D90: (35/35). Mean follow up: 40 months.

Conclusion: Locked screws calcaneal plate used for the fixation of complex articular calcaneal fractures showed no displacement in the primary and secondary healing time. These facts limit the place of initial arthrodesis and streamline the initial recovery process. This may be beneficial for clinical use and the long term follow-up.