SURGICAL-TREATMENT OF THE INTRAARTICULAR CALCANEUS FRACTURE

An understanding of intra-articular calcaneus fractures and their trea tment depends first upon a knowledge of intraosseous anatomy. Generall y, the densest bone is located in the superior and periarticular regio ns. The fracture anatomy involves splitting and displacement of the po sterior facet. Residual posterior facet displacement appears to be an important factor affecting outcome in the operative and nonoperative t reated patients. The treatment ultimately depends on accurate fracture anatomy characterization. Undisplaced fractures are best treated nono peratively. Displaced fractures with less than three major posterior f acet fragments likely require surgical treatment. The recommended proc edure includes a lateral approach, lag screw fixation of the posterior facet, and usage of a small fragment implant. Highly comminuted fract ures remain a dilemma, with individualized treatment recommended.