Open Reduction of Intra-Articular Fractures of the Calaneus through the Lateral Approach

Byun, Young Soo; Kim, Hong Tae; Park, Bong Hoon; Lee, Jae Koo; An, Hyug Su

Abstract

Displaced intra-articular fractures of the calcaneus result in serious and prolonged disability. These injuries continue to pose a therapeutic challange and there remains a great deal of controversy regarding treatment, operative versus nonperative. The lateral approach for open reduction, popularized by Palmer, has been used by many authors, with high percentage of excellent results. We treated 21 displaced intra-articular fractures of the calvaneus in 18 patients by open reduction and internal fixation through the lateral approach from July 1990 to May 1992 and the patients have been followed from 12 to 36 months from the time of their injury. The clinical and radiographic analyses were as follows; 1. The most common cause of injury was falls from a height: 19 fractures in 16 patients(88.8%), Spine fracture was most commonly associated injury : 5 patients (27.8%). 2. Fracture was classified according to classification of Paley and Hall. Eight fractures were tongue type(no comminution 4, with comminution 4), 12 joint depression type(no comminution 8, with comminution 4), and a comminuted type. 3. The average bohler tuber-joint angle was -3.7° (range, -33° to 15°) before operation and 23.0° (range, 5° to 34°) after operation. The final result of cases restored to over 20 of Bohler tuber-joint angle was better than that of cases restored to below 20° (p < 0. 01). 4. At final follow-up, the clinical result was assessed by Rowe' unit system and rated as excellent in 14 cases(66. 7%), good in 5 cases(23. 8%), fair in 2 cases(9. 5%), and poor in none. 5. Bone graft was not done in all cases, but the bony defect was filled with new bone in every case. 6. There were 10 complications in 7 patients: pain in heel pad in 3 cases, checkrein deformity of the toes in a case, residual deformity of the calcaneus in a case, osteomyelitis in case of open comminuted fracture, superficial infection in 2 cases, and transient sensory hypesthesia on the lateral side of the foot in 2 cases, but there was no case to need the additional procedures.