Aim: To compare 2 methods of osteosynthesis (pinning and plate and screws) in displaced intraarticular fractures of the calcaneus

Material and method: Between 2001 and 2005, 82 displaced intraarticular fractures of the calcaneus were surgically treated in our department. Fractures were classified according to Bohler’s classification: 18 Bohler type II and 64 Bohler type III fractures.

Open reduction and reconstruction with osseous grafts (autologous grafts in 22 cases and heterologous grafts in 52 cases) were used in 74 cases. In 8 cases (all of Bohler II type) grafts weren’t used. Osteosynthesis with plate and screws was performed in 26 cases and with pins in 56. The 2 groups were similar in what concerns age, sex ratio, BMI, degree of comminution. The surgical procedure was delayed in both groups (average − 6 days). Pins were removed at 6 weeks and the plates at 12 months.

Results: A number of clinical parameters (pain evolution, moment of partial and full weight bearing, achievement of clinical and radiological union, ankle and forefoot mobility, etc.) were similar in both groups. Skin complications were more frequent in the plate group even if similar lateral surgical approaches were used. Pain along peroneal tendons was much more frequent in the plate group.

Conclusions: Even if theoretically osteosynthesis with plate and screws assures a better fixation, in practice it has similar clinical results with the pinning. The number of complications is higher after plate osteosynthesis. The pins can be extracted with local anesthesia, while plate extraction requires lumbar or general anesthesia and a full extent surgical procedure.

Introduction: Talus fractures are rare, but because of its peculiar anatomy the complications rate is high. Its arterial vascularisation can be compromised by trauma in displaced fractures or by the surgical approaches.

Material and methods: Between 2001 and 2005, 30 patients with talus fractures were surgically treated in the Department of Orthopedics and Traumatology of Bucharest University Hospital. Sex ratio was 3 men/27 men. 27 fractures were closed. The mean age was 37 years (extremes: 17 – 54 years). Fractures were classified according to Hawkins classification: type I – 9 cases, type II – 13 cases, type III – 8 cases. All patients underwent clinical and radiological examinations at 3, 6 and 12 months and every year after this interval.

Results: Hawkins type I fractures were treated by cast immobilization without weight bearing for 6 to 8 weeks. Orthopedic reduction was performed in emergency in order to avoid vascular and cutaneous complications. Hawkins type II and III fractures were surgically treated. Anterior or transmaleolar internal surgical approaches were used. After reduction, osteosynthesis with 2 or 3 compression screws was performed. Avascular necrosis of talus was observed in 6 cases (5 type III fractures, 1 type II case). Cutaneous complications were observed more frequently in type II and III fractures and in the neglected ones. Sepsis occurred in one case. 80% of cases with avascular necrosis developed osteoarthritic changes. Radiological union was observed in average at 6 months.

Conclusions: The prognosis of fracture-dislocation of talus is reserved, because of the high rate of avascular necrosis and osteoarthritis. The most important factors associated with good results are short time interval between trauma and surgical treatment and a perfect reduction. The surgical approach must avoid extensive devascularization of talus neck. Prolonged cast immobilization and long time avoidance of weight bearing favourably influenced fracture union. The most important complication is avascular necrosis.