Displaced intra-articular fractures of the calcaneus: ORIF through an extended lateral approach

Injury. 2019 Jul:50 Suppl 2:S2-S7. doi: 10.1016/j.injury.2019.01.037. Epub 2019 Feb 8.

Abstract

Introduction: Displaced intra-articular calcaneal fractures (DIACF) represent a challenging and controversial issue in traumatology. Conservative treatment has been recommended to avoid surgical problems and complications. The final result, however, is often a painful malunioun of the calcaneus with peroneal impingement. Surgical treatment is gaining acceptance since it offers a chance to restore bone anatomy improving function as long as complications are avoided.

Material and method: We reviewed a series of 59 DIACF treated by a single surgeon during a 9 years period. A clinical and radiological follow-up was obtained in 44 cases (74,6%) (average of 5,5 years; range 2-9). There were 29 males and 15 females with an average age of 54 years (range 25-74). Patients were operated through an extended l-shaped lateral approach and fixation was achieved with lag screws and plate. Outcome measures method included the AOFAS score, the Maryland Foot Score, the Foot Function Index and the SF-36.

Results: The average AOFAS score was 80,5 points. The result was excellent in 18 cases (40,9%), good in 14 cases (31,8%), fair in 10 cases (22,7%) and poor in 2 (4,6%). The mean score for pain was 33,5/40 points, for function 40/50 and for alignment 7/10. Pain was absent in 17 cases (38%), 19 patients (43%) had no functional limitations and 11 (25%) could walk on uneven ground without difficulties. The average FFI score was 25/100 points. The average MFS score was 89/100 points. Subtalar motion was reduced. Reconstruction of the calcaneus was anatomic in 20 cases (45,5%) with an improved clinical outcome. Eight patients (17%) had minor wound healing complications. Three patients (6,8%) required a subtalar arthrodesis after the procedure.

Conclusions: Ostheosytesis through an extended lateral approach restored bone morphology with a reasonable complications rate. The clinical results were good but a normal function and complete subtalar motion were rarely achieved.

Keywords: Calcaneus; Complications; Fractures; Lateral approach; Ostheosyntesis; Results.

MeSH terms

  • Adult
  • Aged
  • Calcaneus / diagnostic imaging
  • Calcaneus / injuries*
  • Conservative Treatment*
  • Female
  • Follow-Up Studies
  • Foot Injuries / diagnostic imaging
  • Foot Injuries / physiopathology
  • Foot Injuries / therapy*
  • Fracture Fixation, Internal*
  • Fracture Healing / physiology*
  • Humans
  • Intra-Articular Fractures / diagnostic imaging
  • Intra-Articular Fractures / physiopathology
  • Intra-Articular Fractures / therapy*
  • Male
  • Middle Aged
  • Postoperative Complications
  • Radiography
  • Range of Motion, Articular / physiology
  • Recovery of Function
  • Retrospective Studies
  • Treatment Outcome
  • Weight-Bearing / physiology