OSTEOSYNTHESIS OF DISPLACED INTRAARTICULAR FRACTURES OF THE CALCANEUS- RESULTS IN 123 CASES

The operative treatment of intraarticular calcaneal fractures has thre e principal aims: restoration of height, length, and width of the calc aneus, reconstruction of the subtalar and calcaneocuboid joint surface s, and stable osteosynthesis using an H-plate or screws. In 68% of the cases, the sustentacular fragment was the key to open reduction, maki ng the medial approach mandatory. In complex fractures, a lateral appr oach is added. In ''blow-out'' fractures or cases with comminution of the sustentacular fragment, an extended lateral approach only is used. For precise preoperative planning of roentgenograms in three planes, four Broden's views and axial plus coroneal or three-dimensional compu ted tomography scans are required. From July 1983 to July 1990, 157 in traarticular calcaneal fractures were treated by open reduction. The r esults in 123 cases are 61% good or excellent, 32.5% satisfactory, and 6.5% poor. The following early complications occurred: superficial wo und edge necrosis (8.3%), hematoma (2.5%), nonunion (1.3%), and infect ion (1.9%). Four patients (3.3%) in the follow-up group have developed degenerative changes severe enough to require subtalar fusion. To fac ilitate the comparison of results, new fracture classification and fol low-up scoring systems have been devised.