Osteosynthesis for intra-articular calcaneal fractures

V Jain, R Kumar, DK Mandal
Department of Orthopaedics, Lady Harding Medical College and Associated Shri Sutcheta Kriplani and Dr Ram Manohar Lohia Hospitals, New Delhi, India

PURPOSE. To correlate treatment results of intra-articular
calcaneal fractures with their computed
tomographic (CT) classification.

METHODS. 36 men and 4 women with 48 intra-articular
calcaneal fractures (8 bilateral) underwent open
reduction and internal fixation with bone grafting via
an extensile lateral approach. Based on 2-dimensional
CT scans, the fractures were categorised using the
Sanders classification. There were 16 type-II, 20
type-III, and 12 type-IV fractures. Radiographs and
Maryland foot scores were used for evaluation of the
results at a mean of 38 (range, 26-66) months.

RESULTS. Anatomic reduction of the posterior
calcaneal facet was achieved in 38 of 48 fractures.
The Bohler and Gissane angles were restored to
between 92 and 99% of normal, respectively. Despite
this, the mean functional scores were 84 in type-II,
83 in type-III and 67 in type-IV fractures.

CONCLUSION. Surgical results were superior in type-II and -III fractures. Type-IV fractures fared poorly,
despite excellent restoration of calcaneal anatomy;
subtalar arthrodesis should have been considered.