Purpose: We assess the results of the surgical treatment of intra-articular fractures of the calcaneus using the Ilizarov external fixator.

Materials and Methods: During the period of January 2004 to June 2009 we treated 72 intra-articular calcaneus fractures in 68 patients, 51 male and 17 female with a mean age of 34 (range 18–56). The mean follow –up period was 2 years and 10 months (range 3 months to 4 years). All patients received preoperative CT-scan to facilitate classification and pre-operative planning. Of the 72 fractures, 37 (51.4%) were Sanders type II, 30 (41.6%) were type III and 5 (7%) were type IV.

The Ilizarov fixator used consisted of 2 rings positioned above the ankle joint and a foot plate. 1.5 and 1.8 mm wires were used, as well as 1.8 mm wires with an olive for the reduction of displaced fragments. Under image intensification and distraction the fracture was reduced and the articular surface was restored as close as possible.

Results: The clinical outcome was excellent in 29 patients (40.4%), good in 32 (44.4%), moderate in 7 (9.7%) and poor in 4 (5.5%). As far as the complications are concerned, we had 17 cases of pin track infection treated with the removal of the pins, ankle joint stiffness in 12 patients treated with physiotherapy, 2 patients developed reflex sympathetic algodystrophy, 2 malunion, 8 developed post-traumatic osteoarthritis and 1 of them underwent subtalar arthrodesis.

Conclusion: The use of the Ilizarov external fixator for the treatment of intra-articular calcanear fractures has proved itself to be an alternative method to O.R.I.F with similarly good results. Given the fact that the learning curve is relatively steep, it has proven, from our experience, to be a safe and valuable tool for the treatment of these challenging fractures.

The external fixation device has successfully been applied in comminuted and unstable fractures of the distal end of the radius. We used the fixator in Smith type fractures, since they are unstable and the literature is quite poor.

Within 2 years, mean follow up time 13 months, we operated 21 patients (8 male, 13 female) aged 17–74 years (average 43 years) with Smith type fracture using Penning type external fixation device. The device remained for 6– 10 weeks (mean time of immobilization 8 weeks). early mobilization – dynamization was not applied to any of the cases.

The final estimation was based on the Gartland and Werley score system and the results were characterized as very good (83%), good (13%) and poor (4%). In those with very good result extension-flexion, supination –pronation of the wrist as well as the power grip were completelly rehabilitated (compared to the healthy limb) within 6 months. In those with good results the outcome was approximately the same to the previous group, involving though complications such as superficial infection, loosening of the pins, 1 case of mild algodystrophy, sensitivity disorders of the radial nerve. All complications were faded after the removal of the device.

Finally there was a case with lose of the reduction and malunion post the removal of the device, poor results due to the early (on the 3 week) mobilazation –dynamization of the wrist.

Despite the good clinical and radiological results, treatment of Smith type fracture with the use of external fixation does not provide earlier and complication free rehabilitation of the wrist, so that should be used in certain cases only.