The operative management of displaced intra-articular fractures of the calcaneum: a two-centre study using a defined protocol

The management of intra-articular calcaneal fractures remains controversial with strong arguments supporting both conservative and operative managemen t. This study assesses the results of open reduction and internal fixation (ORIF) of displaced intra-articular fractures of the calcaneum in two indep endent centres where the indications for operative management had been stri ctly defined. Forty-seven patients (51 fractures) who had sustained such injuries underwe nt an ORIF performed by one of the senior surgeons using the technique desc ribed by Eastwood et al. [JBJS 75-B(1993)189] All of the fractures were ass essed by plain X-ray and CT scan and graded according to the Sanders classi fication [Clin. Orthop. 290(1993)97]. Patients were assessed at a minimum o f 2 years post-surgery both clinically and with a standardised questionnair e based on that described by Kerr et al. [Injury 27(1996)35]. The mean age at operation was 42 and 50 years for the two centres, and the mean follow-up was 44 months. Seventy-six per cent of the patients were mal e. Eighty-eight per cent of the injuries were due to a fall from a height. Fifteen patients had contralateral foot/ankle injuries. Thirty-four of 46 p atients were in employment at the time of the injury, 24 of these were in p hysical jobs and 20 sustained their injury whilst at work. Overall, the satisfaction rate was 90%. Ninety-four per cent of patients in work returned to work at a median of 6 months. Bilateral injuries were ass ociated with a significantly poorer outcome as were those with heel pad pai n. Delay to operation greater than 14 days was associated with a higher inf ection rate. Smoking was not related to infection rate. (C) 2001 Elsevier S cience Ltd. All rights reserved.