CLASSIFICATION AND OSTEOSYNTHESIS OF CALC ANEAL FRACTURES - THE EXTERNAL FIXATOR AS TEMPORARY DISTRACTOR

In the treatment of fractures of the calcaneus, the particularly intri cate local anatomy, complicated fracture forms and associated soft tis sue damage often prejudice operative, anatomical reconstruction. We pr opose a simplified classification that is based on the Regazzoni class ification of 1993 and has six grades of severity. It can be helpful in the selection of operative treatment and, obove all, make it possible to recognize whether operative reconstruction is possible and appropr iate. When operative reconstruction is indicated we fmd the secondary operation important; it is also important to diagnose and treat compar tment syndrome if present and otherwise to take steps to prevent it. I n the first phase, in special cases we use an external fixator without reconstruction of the full length. The operative technique is largely standardized as the fixator is placed only temporarily. Correct posit ioning allows easy correction of shortening or varus deformation, and joint surface reconstruction is also feasible. Autologous bone graftin g is possible. The definitive fixation is achieved with internal plate stabilization by a lateral approach and removal of the fixator. Contr aindications for this procedure are burst fractures with total destruc tion of the joint surfaces and cartilage. Out of 54 fractures we used the fixator to aid reduction in 45. In 71% of these we had very good a nd good results according to the Merle d'Aubigne scoring system.