Open reduction and internal fixation by extensile lateral approach in displaced intra-articular fracture Calcaneum: A study of 44 cases

Abstract

Introduction: Intra-articular fractures of calcaneum pose a challenge for all orthopaedic surgeons due to different treatment options and their varied eventual functional outcome. The aim of this study is to evaluate the medium term outcome of open reduction and internal fixation by extensile lateral approach using low profile anatomical locking calcaneal plate. Method: 44 cases of intra-articular fracture calcaneum in 40 patients were included in this study. These were classified based on Sanders classification system. Open reduction and internal fixation was done using extensile lateral approach and anatomical locking calcaneal plate. Functional outcome was assessed using the Creighton-Nebraska scoring system at the end of six months. Results: Excellent result was seen in 69% cases, Good result in 13% cases, Fair and Poor results were seen in 9% cases each. Bilateral fractures showed poorer results compared to unilateral fractures. Associated injuries had a direct bearing on the eventual functional rehabilitation. Average union time was 12 weeks. Most of the patients could return to pre-injury work status by the end of six months. Conclusion: Immediate, appropriate post-traumatic soft tissue care can probably decrease the incidence of potential wound problems. Extensile lateral approach provides excellent visualization and reduction of displaced intra-articular fragments. Anatomical calcaneal plate provides stable fixation. Role of bone grafting needs further evaluation in a larger population study.