Treatment of intraarticular calcaneal fractures in adults. A treatment algorithm

Significant progress has been made in terms of the management of calcaneal fractures. This is reflected in the marked decrease in complication rates a ssociated with the current intervention of these potentially devastating in juries. The treatment priorities that, in the authors opinion, are key to a chieve best results in a displaced calcaneal fracture are anatomic reconstr uction of the entire calcaneus: articular surfaces, height, alignment, and length, with a function directed postoperative management. The value of the se priorities are confirmed by the authors longterm follow-up results as pr esented here. To reemphasize, conservative treatment should be considered o nly in cases of extraarticular fractures, minor displaced intraarticular fr actures in nonambulatory patients, and in cases where there is a clear cont raindication for surgery. Regarding the technical requirements for an anato mic reconstruction, the os calcis fracture should be categorized as a proce dure for experts. In two-part fractures, according to the Sanders classific ation, an anatomical reduction is obtainable in more than 80%-90% of cases. However, in consideration of the articular cartilage damage, a 70% rate of good to excellent clinical results seems realistic. In three-part fracture s, anatomic reduction is attainable in about 60% of cases with a 70% rate o f good results. These two subgroups comprise about 90% of all calcaneus fra ctures. It is the authors recent experience to optimize the extended latera l approach using posteromedial and anterolateral windows, so that an anatom ic reduction in more than 60% of Sanders Type III os calcis fractures can b e achieved. Further scientific work in this area of trauma orthopedics woul d benefit most from a general consensus on a fracture classification system and on a clinical scoring system, with 5 year follow-up studies using thes e treatment methods and evaluation systems.