OPERATIVE TREATMENT OF CALCANEAL FRACTURES IN ADULTS
Background. Most researches prove that surgery is the only way to a successful treatment result of calcaneal fractures despite poor quality of existing data. However, complications are still frequent. Rehabilitation is rather lengthy and even if the surgery is successful, there is no guarantee for successful final treatment results.
Patients and methods. 48 patients with 52 calcaneal fractures operatively treated in General hospital Celje in the 3-year period were analysed. Plates and screws were used in 67% or wires in 27% of the cases involved. All the patients were reexamined on average 27 months after the injury. The results were evaluated according to the Maryland Foot Score (MFS).
Results. The average MFS result was 72 (SD 20). In 28 cases (58.3%) the results were excellent or good and in 13 cases (27.1%) the results were satisfactory. Only in 7 cases (14.6%) the results were unsatisfactory. The method of treatment, the fragment reduction and the wound healing complications did not show the statistical influence on the final treatment results. After the accidents only 30 of them (71.5%) were still working. They went back to work in approximately 6 months. 18 patients (42.9%) went back to the same position as they had before the accident.
Conclusions. Operative treatment of comminuted calcaneal fractures is accompanied by several complications. Constant use of the up-to-date diagnostic tools (CT) for evaluation of the injury and the treatment, appropriate surgical technique and the experience of the surgeon can reduce the number of the complications and their consequences. As high quality data show that operative treatment as a whole provides no improvement over nonoperative treatment in displaced intra-articular fractures, selection of the patient for surgery is crucial. Calcaneal fractures have a strong and important effect on a patient’s health as well as on his/her employment.
Bridgman SA, Dunn KM, McBride DJ, Richards PJ. Interventions for treating calcaneal fractures. Cochrane Library 2003; 1: –.
Thodarson DB, Krieger LE. Operative versus nonoperative treatment of intraarticular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int 1996; 17: 2–9.
Randle JA, Kreder HJ, Williams SD, Jaglal S, Hu R. Should calcaneal fractures be treated operatively? A meta-analysis. Clin Orthop 2000; 377: 217–27.
Buckley R et al. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures. J Bone Joint Surg 2002; 84A: 1733–44.
Thermann H, Hufner T, Schratt HE, Albrecht K, Tscherne H. Therapie intraartikularer Fersenbeinfrakturen bei Erwachsenen. Ein Behandlungsalgorithmus. Unfallchirurg 1999; 102: 152–66.
Buckley RE, Meek RN. Comparison of open versus closed reduction of intraarticular calcaneal fractures: a matched cohort in workmen. J Orthop Trauma 1992; 6: 195–205.
Sanders R. Displaced intra-articular fractures of the calcaneus. JBJS 2000; 82 A: 225–50.
Zwipp H. Calcaneus Fracturen. In: Zwipp H. Chirurgie des Fusses. Wien: Springer Verlag, 1994: 100–29.
Carr JB. Surgical treatment of the intraarticular calcaneus fracture. Orthopedic Clinics of North America 1994; 4: 665–75.
Boreli J, Lashgari C. Vascularity of the lateral calcaneal flap: A cadaveric injection study. Journal of Orthopaedic Trauma 1999; 2: 73–7.
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