Displaced intra-articular calcaneal fracture treated surgically with limited posterior incision

The incidence of calcaneal fracture has been slowly increasing; however, th e ideal treatment for displaced intra-articular fracture is not available y et, even though the fracture brings frequent complication and disability. B etween April 1991 and March 1998, we treated 103 displaced intra-articular calcaneal fractures of 92 patients surgically with limited posterior incisi on, modified Gallie approach. There were thirty-seven tongue-type fractures , fifteen tongue-type fractures with moderate comminution, nineteen joint-d epression fractures, twenty-nine joint-depression fractures with moderate c omminution, and three extensively comminuted fractures. The fracture fragme nts were fixed mainly with partly threaded small cancellous screws or Stein mann pins without any bone graft. Ankle and subtalar motion was permitted i mmediately if fixation were stable enough. Otherwise, a short period of cas t immobilization was utilized. With a mean follow-up of 28 months (range, 1 2 to 66 months), eighty six percent of feet had no pain or only occasional pain not requiring medication. Using American Orthopedic Foot and Ankle Soc iety hindfoot score system for assessment, ninety percent of feet rated as good to excellent. We used "Circle draw test" for evaluation of subtalar mo tion during follow-up visitation and found eight-seven percent of feet show ed good to excellent correlation with the functional recovery. We recommend a limited posterior incision for reduction and internal fixation of displa ced intra-articular calcaneal fractures. For displaced intra-articular frac tures with three or four large fragments without further comminution and wi thout a displaced fracture of the calcaneal cuboid joint, this method is pa rticularly useful. We also recommend a Circle draw test for evaluation of s ubtalar joint motion as well as an indicator of functional recovery after d isplaced calcaneal fractures.