Opinions is divided among surgeons whether to operatively fix displaced calcaneal fractures in elderly patients and heavy smokers. In a long term follow-up of operatively treated calcaneal fractures, we considered several factors that could affect outcomes and complication rates.

Method: 59 calcaneal fractures in 54 patients that underwent operative fixation for displaced intra-articular fractures from April 1995 to January 2006 were reviewed. There were 18 Tongue type and 41 Joint depression fractures on X-rays. Of 38 available CT scans, 25 were Sanders Type II and 13 were Types III and IV fractures.

Average interval to surgery was 6 days. Postoperative mobilisation regime was passive range of motion immediately following surgery with non weight bearing for 6 weeks. Weight bearing was started at 6–8 weeks. On follow-up, patients were assessed with clinical and radiological exam, completed Short Form-36 (SF-36), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and Visual Analogue Scale (VAS) scores.

Results: The duration of follow-up was between 6 months to 11.2 years (6.4 years). The pre and post operative Bohler angles were 8° ± 11° and 29° ± 6° respectively. There was significant limitation of subtalar movement on the operated side irrespective of the presence of arthritis. The average AOFAS, SF-36 and VAS scores were 79, 58 and 3 respectively. Good results were associated with age < 50 years, ASA grade I, pre-op Bohler angle of < 5° and Sanders < IIC. 89% of patients returned to their previous level of activity after an average of 6.5 months.

Smoking was not associated with early or late complication rates and did not affect outcome.

Conclusions: We think that advanced age and smoking are not contraindications for operative fixation of displaced calcaneal fractures.

Opinions differ among surgeons whether to operatively fix displaced calcaneal fractures in smokers. In a long term follow-up of operatively treated calcaneal fractures, we considered several factors that could affecting outcomes and complications.

Method: 59 calcaneal fractures in 54 patients that underwent operative fixation for displaced intra-articular fractures from April 1995 to January 2006 were reviewed. There were 18 Tongue type and 41 Joint depression fractures on X-rays. Of 38 available CT scans, 25 were Sanders Type II and 13 were Types III and IV fractures.

Average interval to surgery was 6 days. Postoperative mobilisation regime was passive range of motion immediately following surgery with non weight bearing for 6 weeks. Weight bearing was started at 6–8 weeks. On follow-up, patients were assessed with clinical and radiological exam, completed Short Form-36 (SF-36), the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and Visual Analogue Scale (VAS) scores.

Results: The duration of follow-up was between 6 months to 11.2 years (6.4 years). The pre and post operative Bohler angles were 8° ± 11° and 29° ± 6° respectively. There was significant limitation of subtalar movement on the operated side irrespective of the presence of arthritis. The average AOFAS, SF-36 and VAS scores were 79, 58 and 3 respectively. Good results were associated with age < 50 years, ASA grade I, pre-op Bohler angle of < 5° and Sanders < IIC. 89% of patients returned to their previous level of activity after an average of 6.5 months.

Smoking was not associated with early or late complication rates and did not affect outcome.

Conclusions: We think that smoking is not a contraindication for operative fixation of displaced calcaneal fractures.

Purpose: To evaluate the effectiveness of the Ponseti method of the treatment i late presentation of clubfeet.

Method: Prospective study comprising 91 patients(141 feet) between August 2003 and September 2005. Age range was from 7 dats to 20 months. Majority of patients belonged to Dimeglio grade 3 (75%) and Pirani grade 4(43%) at presentation. All were treated by Ponseti method of serial casting with or wothout tendo-achillis lengthening. Tendon lengthening was required in 79% of patients. The average duration of follow up was 1.5 years.

Results: Recurrence of deformity was seen in patients who presented late and had severe deformity at time of presentation. The Ponseti technique failed to achieve correction in 4 patients. Follow up at 2 years showed overall correction rate of 95%. In develpoing countries, delayed presentation could signifucantly affect the final outcomes as the joint deformities progressively become fixed. Our study showed that number of corrective casts, recurrence of deformity and the nned for tendoachillis lengthening was inversly related to the time of presentation. This technique can be relable used to correct clubfeet even in delayed present.