Current Concepts Review: Intra-Articular Fractures of the Calcaneus

Abstract

1) Intra-articular fractures of the calcaneus are associated with severe long-term consequences for function and pain. The condition of the soft tissues is of paramount importance when determining the method of treatment,the timing of surgery, and the post-injury rehabilitation.2) Intra-articular fractures are difficult to fully evaluate with plain radiographs. Computed tomography may assist in assessing the fracture pattern and planning for surgery. The likelihood of a good to excellent outcome is increased when an anatomic reduction is obtained.3) The outcome after operative management is difficult to characterize and appears to be influenced by factors related to the fracture, the patient, and the experience of the institution where the patient obtains treatment.All these factors should be factors in the decision to operate, but no single factor reliably determines the most appropriate treatment.4) Open reduction and internal fixation through an extensile approach achieves acceptable results in carefully selected patients. The use of a limited exposure with minimally invasive techniques may decrease the incidence of wound complications. However, this option is technically demanding and the quality of the reduction achieved may be more difficult to obtain and determine intraoperatively. Open fractures should be promptly debrided. The choice of fixation after reduction is based on the surgeons assessment of the soft tissue and the risk of infection.5) Post-traumatic arthritis of the subtalar joint is a common complication. Successful salvage can be achieved with a subtalar arthrodesis. However, these results may be influenced by the institution at which the initial management was rendered.

Treatment of Displaced Intra-articular Calcaneal Fractures by Intramedullary Nail. Preliminary Report

“…Open reduction with LCP plate fixation allows for anatomical reduction, stable osteosynthesis and excel lent or good outcomes even in 80% of the cases [13,14]. However, the procedure is relatively often associated with wound healing complications, skin necrosis or infections [15,16]. The incidence of these problems has been estimated at 33% in retrospective studies and 16% in a randomised prospective study [17,18].…”

“…Meto da otwar tej re po zy cji i ze spo le nia pły tą LCP umożli wia ana to micz ną re po zy cję, sta bil ną oste osyn te zę i po zwa la uzy skać bar dzo do bre i do bre wy ni ki nawet w 80% przy pad ków [13,14]. Sto sun ko wo czę sto jed nak ob ser wu je się pro blem z go je niem ra ny, martwi cą skó ry lub in fek cją [15,16]. Czę stość wy stę powa nia tych pro ble mów oce nia się na 33% w ba da niach re tro spek tyw nych oraz 16% w ran do mi zo wa nym bada niu pro spek tyw nym [17,18].…”

Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation: A review

“…29 With less serious implant problems, such as occasional local pain, nonsurgical treatments including nonsteroidal anti-inflammatory drugs and physical therapy can be attempted. 30 In addition, if nonsurgical treatment is unsuccessful or if symptoms are severe or worsen, early surgical removal of the implant should be performed. 17 However, in the authors' opinions, the incidence of implant problems is quite low, and the rates of implant failure and loosening have yet to be reported.…”

A biomechanical comparison of fixed angle locking compression plate osteosynthesis and cement augmented screw osteosynthesis in the management of intra articular calcaneal fractures

“…Fixed-angle locking compression plate osteosynthesis through the lateral approach is currently the gold standard procedure for the surgical management of calcaneal fractures [1][2][3]. The extensile lateral approach, however, is often associated with soft tissue complications [4,5].…”