MANAGEMENT OF CALCANEAL FRACTURES IN ADULTS - CONSERVATIVE VERSUS OPERATIVE TREATMENT

Significant progress has been made in the management of calcaneal frac tures. This is reflected in the marked decrease in complication rates associated with the current intervention of these potentially devastat ing injuries. The treatment priorities that are key to achieve best re sults in a displaced calcaneal fracture are an anatomic reconstruction of the entire calcaneus including articular surfaces, height, alignme nt, and length, with a function directed postoperative management. The value of these priorities is confirmed by long term followup results. Conservative treatment should be considered only in cases of extraart icular fractures, in cases of minor displaced intraarticular fractures in patients who are nonambulatory, and in cases where there is a clea r contraindication for surgery. An anatomic reconstruction of an os ca lcis fracture is difficult to obtain. In two-part fractures, according to the classification described by Sanders et al, an anatomic reducti on is obtainable in more than 80% of cases. However, if the articular cartilage damage that is typically present is considered, a 70% rate o f good to excellent clinical results is more realistic. In three-part fractures, anatomic reduction is attainable in approximately 60% of ca ses with a 70% rate of good results. These two subgroups comprise appr oximately 90% of all calcaneal fractures. It has been put into practic e recently to optimize the extended lateral approach using posteromedi al and anterolateral windows, so that an anatomic reduction can be ach ieved in more than 60% of os calcis fractures considered as Type III a ccording to the classification described by Sanders et al. Additional scientific work in this area of trauma orthopaedics would benefit most from a general consensus on a fracture classification system and on a clinical scoring system, with 5-year followup studies using these tre atment methods and evaluation systems.