Operative Treatment of Intra-articular Calcaneal Fractures by Posterior Approaeh

Kim, Youn Soo; Park, Ckoong Seo; Chu, In Tak; Kim, Hyoung Min; Ryu, Jae Duk

Abstract

In contrast to the extra-articular calcaneal fractures, the treatment of intra-articular fractures is very difficult and the final result is not always satisfactory, because it has not only difficulties in the identification of the exact fracture pattern and an anatomical reduction of the fracture fragments, but also no principle of ideal treatment. Today, numerous controversies remain regarding the treatment of intra-articular calcaneal fractures, which include the need of reduction, the method of reduction, the surgical approach. the method of fixation, and the need of bone graft. We propose the posterior approach and longitudinal buttress screw fixation for the treatment of intra-articular calcaneal fractures. The posterior approach allows excellent visualization of the posterior facet of subtalar joint, and the longitudinal screw buttresses the posterior facrt fracture fragment of calcaneus. From Dec. 1990 to May 1992, 17 intra-articular calcaneal fractures out of 15 patients were treated by our surgical method and followed up (average, 9.2 months) in 12 cases out of 10 patients (2 bilateral cases). Seven cases were tongue type fractures and five were joint do- pression type. Operations were performed 5 to 15 days after accident(average, 92 days). Bone graft was performed only 3 cases. At last follow-up, there was no pain in 8 cases. intermittant dull pain in 3, and resting pain in 1. The Bohlers angle at post-accident and last follow-up were 5.9 and 30.7 in tongue type : 10.6 and 32.6 in joint depression type. The reduction of the fracturr fragments was maintained well and secondary deformities were not developed in all cases. Based on these findings in this study, most of the intra-articular calcaneal fractures can be reduced anatomically by posterior approach, and fracture fragment maintained by longitudinal buttress screw fixation.