SLR - June 2013 - Clark Johnson
Reference: Gulabi D, Sari F, Sen C, Avci C, Saglam F, Erdem M, Bulut G. Mid-term Results of Calcaneus Plating for Displaced Intraarticular Calcaneus Fractures, Ulus Travma Acil Cerrahi Derg. 2013;19(2):145-15
Scientific Literature Review
Reviewed by: Clark Johnson, DPM
Residency Program: North Colorado Medical Center Podiatric Medicine and Surgery Residenc
Podiatric Relevance: Displaced intraarticular calcaneus fractures are a cause of long-term pain, pedal dysfunction, and often require eventual subtalar joint arthrodesis. Calcaneus fractures most often occur as a result of high-energy trauma and make up approximately 2 percent of all fractures. Intraarticular calcaneus fractures make up 75 percent of all calcaneus fractures. Anatomic reduction can be difficult, especially in the face of concerns over the soft-tissue envelope. Patients who have experienced displaced intraarticular calcaneus fractures often complain of pain and stiffness of the subtalar and surrounding joints, lateral foot pain and difficulty with shoe wear. The standard traditional treatment has been open reduction internal fixation, or primary subtalar joint arthrodesis for these traumatic injuries. Some authors have described success with nonsurgical treatment methods.
Methods: This is a retrospective study of 26 patients with 27 displaced intraarticular calcaneus fractures. Eighty-one percent of study participants were male, and the average age was 29.2 years (18-61 years). Twenty-five patients had unilateral displaced intraarticular calcaneus fractures, and six patients had contralateral non-displaced extraarticular calcaneus fractures, which were treated non-surgically. The time interval from injury to surgery averaged eight days (4-22), and a plaster brace was utilized in the interim. Eighteen patients received Sherman reconstruction plates and nine patients received Sanders anatomic calcaneus plates. Autogenous bone graft was used in 18 patients, allogeneic bone graft in eight.
Results: Twelve fractures were classified as Sanders type 2, 10 as type 3 and 5 as type 4. Average follow-up time was 34.4 months (19-85 months). The Maryland foot score and Creighton-Nebraska score were used and stratified by Sanders fracture classification. By the Maryland foot score, six patients reported very good results, 15 patients reported good results and five patients reported average results. According the Creighton-Nebraska score, very good results were obtained in seven patients, good results were seen in 12 patients, intermediate results in six patients, and bad results in one patient. Both the Bohler and Gissane angles were improved at last follow-up with use of both the Sanders and Sherman plates. Four patients experienced superficial soft tissue infections and two patients developed small skin necrosis. All complications were treated successfully with oral antibiotics and/or local wound care
Conclusions: The results of this study indicate that open reduction internal fixation of displaced intraarticular calcaneus fractures is an appropriate and successful treatment method. Surgery should be performed once the soft-tissue envelope demonstrates satisfactory health, so as to minimize post-operative complications. Basic osteosynthesis principles such as atraumatic surgical technique, anatomic reduction, stable internal fixation, and early range of motion should be remembered in treating these complex traumatic injuries. Use of bone grafting remains controversial, but this study provides some support for its use, though the lack of a control group limits this finding.