FOLLOW-UP EVALUATION OF OPEN INTRAARTICULAR FRACTURES OF THE CALCANEUS

The results of a follow-up evaluation of open intra-articular calcanea l fractures are presented. A modified Merle d'Aubigne functional score and Zwipp radiographic score were used. A retrospective analysis of 3 5 patients with 36 open intra-articular fractures represents the basis of the study. At the time of follow-up examination (on average 44 mon ths after the injury), 5 amputations of the affected extremity and 4 a nkle arthrodeses had been carried out. The 23 patients still able to b ear weight on the affected hindfoot and possessing a functional ankle joint were radiographically and functionally evaluated. No excellent r esults were documented. Only 6 good functional and 2 good radiographic outcomes were noted. in 17 instances, a poor functional or radiograph ic score was given. Devastating results were seen in the course of tre atment of third-degree open joint depression or comminuted intra-artic ular fractures (n = 15): 9 cases of osteomyelitis, 5 amputations, 1 pa rtial calcanectomy, 1 arthrodesis. An open reduction as part of the pr imary treatment (n = 6) led to local complications in all instances. T he most favorable results were seen after nonoperative fracture manage ment: complication-free course of treatment in 4 of 11 patients. All w orkmen's injuries led to a permanent disability, and these patients re ceived compensation. The treatment and salvage of the soft-tissue enve lope should be paramount in all therapeutic decisions. The fracture tr eatment must not further jeopardize these tissues. An aggressive opera tive treatment of local complications, including arthrodesis or amputa tion, is recommended.