OPERATIVE TREATMENT OF DISPLACED INTRAARTICULAR FRACTURES OF THE OS CALCIS WITH THE ASIF CALCANEAL PLATE

From August 1992 to March 1997, 66 patients with 71 displaced intraart icular calcaneal fractures were prospectively examined after an operat ive treatment using an extended lateral approach and the ASIF calcanea l plate followed by early functional postoperative treatment (mean fol low-up 25 months, retrieval rate 96 %). To classify the type of fractu re and to verify the results of reduction and of retention CT scans in the coronal and transverse plane were performed pre- and postoperativ ely and on the day of assessment. The Zwipp Score was used for clinica l evaluation. After fractures with 5 to 8 points according to the calc aneal fracture scale, 97% of the patients had an anatomical or near an atomical reduction of the posterior facet and the clinical outcome in 82 % of the patients was graded as good or excellent. In 70 % of patie nts with a fracture rated 9 to 10 points a good reduction was demonstr ated and clinically there were 67 % good or excellent results. But in the fractures with 11 to 12 points, despite 40 % good reductions, the clinical outcome was graded as good in 10 % of the patients only. Howe ver, if the postoperative displacement of the posterior facet was more than 2 mm no patient had a good result independent of the type of fra cture. Due to restoration of the geometry of the most comminuted fract ure types and the immediate partial weight bearing secondary soft tiss ue problems could be minimized without any loss of articular reduction . Anatomical reduction and stable internal fixation together with adeq uate physical therapy are apparently preconditions but not a guarantee for a good clinical result after displaced calcaneal fractures.