Intra-Articular Fractures of the Calcaneus: Open reduction and internal fixation via extended lateral transcalcaneal approach

Hwang, Chung Soo; Chung, Phil Hyun; Kang, Suk; Kim, Yong Min; Oh, Hyung Ho; Chae, Dong Joo; Park, Min Hyo; Kim, Jee Hong; Cho, Yun Chul

Abstract

Fractures with displaced articular facet of subtalar joint occupies 60-75% of whole calcaneal fractures. Nowadays, general principle of treatment for displaced intraarticular fracture has become anatomical reduction of joint surface and rigid fixation of the fracture. However, it had been difficult to apply this principle in cases of calcaneus due to various obstacles such as anatomical characteristics, therefore outcomes were not satisfactory in many cases. Extended lateral approach, which was designed by Letournel and Benirschke, contributed greatly in overcoming those obstacles. From August 1992 to April 1994, the author managed fifteen displaced intraarticular fractures of the calcaneus in fourteen patients with open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate. The fractures were examined preoperatively with Brodens view and classified according to Eastwood(1992) with 2-plane CT. All the fractures united within postoperative 20 weeks(average 10.9 weeks). Final results were assessed by the clinical criteria for calcaneal fracture designed in Greighton Nebraska Health Foundation. Among the 15 cases, excellent results were obtained in eight cases, good in six, fair in one. There were no remarkable complications at the latest follow-up. In managing displaced intraarticular fractures of calcaneus, open reduction of displaced intraarticular fragment via extended lateral approach and internal fixation using reconstruction plate seemed to be very useful and harmless method.