Surgical Treatment of Calcaneal Comminuted Intrarticular Fractures: Long-Term Follow-Up

M. Haddad, Z. Horesh, M. Soudry, N. Rosenberg

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Laboratory of Musculoskeletal Research, Orthopedic Department, Rambam-Health Care Campus, Haifa, Israel.

DOI: 10.4236/ojcd.2014.43019                

Abstract

There is a controversy whether the comminuted calcaneal fractures should benefit more from conservative or from surgical treatment. Aiming to contribute to this unsolved clinical question we reviewed the long-term outcome (up to 96 months) of in 44 patients (mean age 35 years) with 47 calcaneal fractures who were treated surgically. In these patients open reduction and internal fixation were performed using a calcaneal reconstruction plate. The functional outcome was measured according to the Rowe Score and the level of pain by Visual Analog Scale. The objective outcome was estimated by the current radiographs. The clinical results were good to excellent in 69% of patients. Poor outcome observed in one patient who developed Complex Regional Pain Syndrome in his foot. The radiographic evaluation showed satisfactory reconstruction (according to the Boehler angle measurements) in 35 of operated calcanei. These results indicate on the satisfactory outcome of surgical treatment in the majority of the patients who were diagnosed with comminuted fracture of calcaneus.

Keywords

Calcaneus, Fracture, Surgical Treatment

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Sanders, R. (2000) Displaced Intra-Articular Fractures of the Calcaneus. The Journal of Bone and Joint Surgery, 82A, 225-250.
[2]	Herscovici Jr., D., Widmaier, J., Scaduto, J.M., Sanders, R.W. and Walling, A. (2005) Operative Treatment of Calcaneal Fractures in Elderly Patients. The Journal of Bone and Joint Surgery, 87A, 1260-1264. http://dx.doi.org/10.2106/JBJS.D.01765
[3]	Huang, P.J., Huang, H.T., Chen, T.B., Chen, J.C., Lin, Y.K., Cheng, Y.M. and Lin, S.Y. (2002) Open Reduction and Internal Fixation of Displaced Intraarticular Fractures of the Calcaneus. Journal of Trauma-Injury Infection & Critical Care, 52, 946-950. http://dx.doi.org/10.1097/00005373-200205000-00021
[4]	Macey, L.R., Benirschke, S.K., Sangeorzan, B.J. and Hansen, S.T. (1994) Acute Calcaneal Fractures: Treatment Options and Results. The Journal of the American Academy of Orthopaedic Surgeons, 2, 36-43.
[5]	Sanders, R., Fortin, P., DiPasquale, T. and Walling, A. (1993) Operative Treatment in 120 Displaced Intraarticular Calcaneal Fractures. Results Using a Prognostic Computed Tomography Scan Classification. Clinical Orthopaedics and Related Research, 290, 87-95.
[6]	Kundel, K., Funk, E., Brutscher, M. and Bickel, R. (1996) Calcaneal Fractures: Operative versus Nonoperative Treatment. Journal of Trauma-Injury Infection & Critical Care, 41, 839-845. http://dx.doi.org/10.1097/00005373-199611000-00012
[7]	Dooley, P., Buckley, R., Tough, S., McCormack, B., Pate, G., Leighton, R., Petrie, D. and Galpin, B. (2004) Bilateral Calcaneal Fractures: Operative versus Nonoperative Treatment. Foot & Ankle International, 25, 47-52.
[8]	Barla, J., Buckley, R., McCormack, R., Pate, G., Leighton, R., Petrie, D. and Galpin, R. (2004) Displaced Intraarticular Calcaneal Fractures: Long-Term Outcome in Women. Foot & Ankle International, 25, 853-856.
[9]	Brauer, C.A., Manns, B.J., Ko, M., Donaldson, C. and Buckley, R. (2005) An Economic Evaluation of Operative Compared with Nonoperative Management of Displaced Intra-Articular Calcaneal Fractures. The Journal of Bone and Joint Surgery, 87A, 2741-2749.
[10]	Buckley, R., Tough, S., McCormack, R., Pate, G., Leighton, R., Petrie, D. and Galpin, R. (2002) Operative Compared with Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures: A Prospective, Randomized, Controlled Multicenter Trial. Journal of Bone and Joint Surgery, 84, 1733-1744.
[11]	Babin, S.R., Graf, P., Katzner, M. and Schwingt, E. (1982) Reconstruction-ostéosynthèse par plaque vissée des fractures thalamiques du calcanéum. Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur, 68, 557-569.
[12]	Nehme, A., Chaminade, B., Chiron, P., Fabie, F., Tricoire, J.L. and Puget, J. (2004) Percutaneous Fluoroscopic and Arthroscopic Controlled Screw Fixation of Posterior Facet Fractures of the Calcaneus. Revue de Chirurgie Orthopédique et Réparatrice de l’Appareil Moteur, 90, 256-264. http://dx.doi.org/10.1016/S0035-1040(04)70102-6
[13]	Loucks, C. and Buckley, R. (1999) Bohler’s Angle: Correlation with Outcome in Displaced Intra-Articular Calcaneal Fractures. Journal of Orthopaedic Trauma, 13, 554-558. http://dx.doi.org/10.1097/00005131-199911000-00007
[14]	Daftary, A., Haims, A.H., and Baumgaertner, M.R. (2005) Fractures of the Calcaneus: A Review with Emphasis on CT. Radiographics, 25, 1215-1226. http://dx.doi.org/10.1148/rg.255045713
[15]	Buckley, R.E. and Meek, R.N. (1992) Comparison of Open versus Closed Reduction Of Intraarticular Calcaneal Fractures: A Matched Cohort in Workmen. Journal of Orthopaedic Trauma, 6, 216-222. http://dx.doi.org/10.1097/00005131-199206000-00014
[16]	Knight, J.R., Gross, E.A., Bradley, G.H., Bay, C. and LoVecchio, F. (2006) Boehler’s Angle and the Critical Angle of Gissane Are of Limited Use in Diagnosing Calcaneus Fractures in the ED. American Journal of Emergency Medicine, 24, 423-427.
[17]	Mueller, J.E., Ilchmann, T. and Lowatscheff, T. (2001) The Musculocutaneous Sural Artery Flap for Soft-Tissue Coverage after Calcaneal Fracture. Archives of Orthopaedic and Trauma Surgery, 121, 350-352. http://dx.doi.org/10.1007/s004020000238