J Korean Foot Ankle Soc.  2015 Dec;19(4):137-141. 10.14193/jkfas.2015.19.4.137.

Management of Displaced Intra-articular Calcaneal Fracture

• Lee JY
• Na WC

• KMID: 2132454
• DOI: http://doi.org/10.14193/jkfas.2015.19.4.137

Abstract

Recently, open reduction and internal fixation has been the treatment of choice for displaced intra-articular calcaneal fractures for many orthopaedic surgeons. However controversy still surrounds the optimal treatment with regard to whether displaced intra-articular calcaneal fractures should be treated operatively or conservatively. Conservative treatments include use of splint, rest, leg elevation, icing, use of analgesics and early mobilization. Operative treatment is open reduction and internal fixation, performed through an extensile lateral approach with interfragmentary screws and application of a neutralization plate. We reviewed the question of whether operative treatment by open reduction and internal fixation provides a benefit compared with conservative treatment for displaced intra-articular calcaneal fractures.

Keyword

Calcaneal fracture; Conservative treatment; Open reduction and internal fixation

MeSH Terms

Analgesics
Early Ambulation
Leg
Splints
Analgesics

Figure

• 

  Figure 1. Initial calcaneal lateral (A) and axial (B) view show joint depression type of intra-articular calcaneal fracture. (C, D) After 7 months of conservative treatment, subtalar arthrosis (malunion) has been occurred.

• 

  Figure 2. (A) L-shaped line was drawn line was drawn over the lateral aspect of calcaneus, running between the lateral malleolus and the posterior and inferior border of the heel. (B) Intraoperative photograph shows a full thickness anterior flap elevated with no touch technique. (C) Postoperative lateral radiograph is taken after open reduction and fixation of a displaced intra-articular calcaneal fracture.

Reference

References

1. Giachino AA, Uhthoff HK. Intra-articular fractures of the calcaneus. J Bone Joint Surg Am1. 1989; 71:784–7.

2. Järvholm U, Körner L, Thorén O, Wiklund LM. Fractures of the calcaneus. A comparison of open and closed treatment. Acta Orthop Scand1. 1984; 55:652–6.

3. Lindsay WR, Dewar FP. Fractures of the os calcis. Am J Surg. 1958; 95:555–76.

4. Palmer 1. The mechanism and treatment of fractures of the calcaneus; open reduction with the use of cancellous grafts. J Bone Joint Surg Am. 1948; 30:2–8.

5. Sanders R. Displaced intraarticular fractures of the calcaneus. J Bone Joint Surg Am. 2000; 82:225–50.

6. Kundel K, Funk E, Brutscher M, Bickel R. Calcaneal fractures: operative versus nonoperative treatment. J Trauma. 1996; 41:839–45.

7. Thordarson DB, Krieger LE. Operative vs. nonoperative treatment of intraarticular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int. 1996; 17:2–9.

8. Essex-Lopresti P. The mechanism, reduction technique, and results in fractures of the os calcis. Br J Surg. 1952; 39:395–419.

9. Ibrahim T, Rowsell M, Rennie W, Brown AR, Taylor GJ, Gregg PJ. Displaced intraarticular calcaneal fractures: 15-year follow-up of a randomised controlled trial of conservative versus operative treatment. Injury. 2007; 38:848–55.

10. Eastwood DM, Langkamer VG, Atkins RM. Intra-articular fractures of the calcaneum. Part II: open reduction and internal fixation by the extended lateral transcalcaneal approach. J Bone Joint Surg Br. 1993; 75:189–95.

11. Bajammal S, Tornetta P 3rd, Sanders D, Bhandari M. Displaced intraarticular calcaneal fractures. J Orthop Trauma. 2005; 19:360–4.

12. Bruce J, Sutherland A. Surgical versus conservative interventions for displaced intraarticular calcaneal fractures. Cochrane Database Syst Rev. 2013; 1:CD008628.

13. Gougoulias N, Khanna A, McBride DJ, Maffulli N. Management of calcaneal fractures: systematic review of randomized trials. Br Med Bull. 2009; 92:153–67.

14. Jiang N, Lin QR, Diao XC, Wu L, Yu B. Surgical versus nonsurgical treatment of displaced intraarticular calcaneal fracture: a metaanalysis of current evidence base. Int Orthop. 2012; 36:1615–22.

15. Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma. 1999; 13:369–72.

16. Crosby LA, Fitzgibbons T. Intraarticular calcaneal fractures. Results of closed treatment. Clin Orthop Relat Res. 1993; 290:47–54.

17. Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, et al. UK Heel Fracture Trial Investigators. Operative versus nonoperative treatment for closed, displaced, intraarticular fractures of the calcaneus: randomised controlled trial. BMJ. 2014; 349:g4483.

18. Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, et al. Operative compared with nonoperative treatment of displaced intraarticular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2002; 84:1733–44.

19. Parmar HV, Triffitt PD, Gregg PJ. Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study. J Bone Joint Surg Br. 1993; 75:932–7.

20. Howard JL, Buckley R, McCormack R, Pate G, Leighton R, Petrie D, et al. Complications following management of displaced intraarticular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma. 2003; 17:241–9.

21. Radnay CS, Clare MP, Sanders RW. Subtalar fusion after displaced intraarticular calcaneal fractures: does initial operative treatment matter? J Bone Joint Surg Am. 2009; 91:541–6.

22. Backes M, Schepers T, Beerekamp MS, Luitse JS, Goslings JC, Schep NW. Wound infections following open reduction and internal fixation of calcaneal fractures with an extended lateral approach. Int Orthop. 2014; 38:767–73.

23. O'Farrell DA, O'Byrne JM, McCabe JP, Stephens MM. Fractures of the os calcis: improved results with internal fixation. Injury. 1993; 24:263–5.

24. Sanders R. Intra-articular fractures of the calcaneus: present state of the art. J Orthop Trauma. 1992; 6:252–65.

25. Zwipp H, Tscherne H, Thermann H, Weber T. Osteosynthesis of displaced intraarticular fractures of the calcaneus. Results in 123 cases. Clin Orthop Relat Res. 1993; 290:76–86.

26. Randle JA, Kreder HJ, Stephen D, Williams J, Jaglal S, Hu R. Should calcaneal fractures be treated surgically? A metaanalysis. Clin Orthop Relat Res. 2000; 377:217–27.

27. Buckley RE, Meek RN. Comparison of open versus closed reduction of intraarticular calcaneal fractures: a matched cohort in workmen. J Orthop Trauma. 1992; 6:216–22.

28. De Boer AS, Van Lieshout EM, Den Hartog D, Weerts B, Verhofs-tad MH, Schepers T. Functional outcome and patient satisfaction after displaced intraarticular calcaneal fractures: a comparison among open, percutaneous, and nonoperative treatment. J Foot Ankle Surg. 2015; 54:298–305.

29. Agren PH, Wretenberg P, Sayed-Noor AS. Operative versus nonoperative treatment of displaced intraarticular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2013; 95:1351–7.

30. DeWall M, Henderson CE, McKinley TO, Phelps T, Dolan L, Marsh JL. Percutaneous reduction and fixation of displaced intraarticular calcaneus fractures. J Orthop Trauma. 2010; 24:466–72.

31. Rammelt S, Amlang M, Barthel S, Gavlik JM, Zwipp H. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res. 2010; 468:983–90.

32. Schepers T, Patka P. Treatment of displaced intraarticular calcaneal fractures by ligamentotaxis: current concepts' review. Arch Orthop Trauma Surg. 2009; 129:1677–83.

33. Tomesen T, Biert J, Frölke JP. Treatment of displaced intraarticular calcaneal fractures with closed reduction and percutaneous screw fixation. J Bone Joint Surg Am. 2011; 93:920–8.

34. Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems for the ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int. 1994; 15:349–53.

35. Barla J, Buckley R, McCormack R, Pate G, Leighton R, Petrie D, et al. Canadian Orthopaedic Trauma Society. Displaced intraarticular calcaneal fractures: longterm outcome in women. Foot Ankle Int. 2004; 25:853–6.

36. O'Brien J, Buckley R, McCormack R, Pate G, Leighton R, Petrie D, et al. Personal gait satisfaction after displaced intraarticular calcaneal fractures: a 2–8 year followup. Foot Ankle Int. 2004; 25:657–65.