Open reduction and internal fixation of displaced intra-articular calcaneal fractures

OPEN REDUCTION AND INTERNAL FIXATION OF DISPLACED INTRA-ARTICULAR CALCANEAL FRACTURES We reviewed 42 displaced intra articular calcaneal fractures(36 patients) that were treated with open reduction and internal fixation between 2006-2013 at Orthopaedics and Traumatology Clinic of Adnan Menderes University Faculty of Medicine Hospital. The average age was 43,1 (17-70) and mean follow up time was 28.7 (7-64) months. There were 28 males (%77.8), 8 females (%22.2). 6 patients (%16.7) had bilateral calcaneus fracture. Two of all fractures were open fracture (%5.6).Ten of all fracture were at right side (%27.8), 20 of all fracture were at left side (%25.6) and 6 patients had bilateral fracture. 16 of the patients were worker, two of them were farmers, retired people were six of them, five of them were housewives, two of them driver, two of them were students. The mechanism of injury was falls from height in 35 patients, 1 patient with motor vehicle accident. Some of them had another fractures Associated fractures were present in 5 patients. Patients' preoperative and postoperative radiographs were analyzed and based on radiological union time, Böhler and Gisanne angles. Sanders classification system used for fracture clasification. The preoperative Böhler and Gissane angles were 4.8° and 128° respectively. All the patients were approached through an extended lateral incision. The average time between the injury and operation day was 10 (4-30) days. AOFAS ankle-hindfoot scale and Maryland scala were used for cilinical evaluation. Postoperative Böhler and Gissane angles were 29° and 133° respectively. In 26 calcaneus fracture allogreft were used (%61.9).According to the AOFAS scores of 42 fractures there were 8 (% 19) excellent, 18 (% 42.8) good, 10 (% 23.8) fair and 6 were (% 14,2) poor results. The patients whose scores were poor had average 65 points and they had Sanders type 4 fractures. According to the Maryland scores 42 foot; 11 excellent (%26.1), 22 good (% 52.3), 8 fair ( %19), 1 was poor (%22.3). After surgery, 16 foot of 13 patients (% 38) had some complications. Four (9.6%) patients, wound disruption and superficial infection, six patients Sudeck atrophy (14.2%), in 1 patient osteomyelitis, deep infection was detected in 5 patients (%11.9). Displaced intra-articular calcaneal fractures, open reduction and internal fixation is now a priority treatment. With this approach, good results, but will develop postoperative complications are the most important factor that hinders the success of the treatment. To this end, provisions are necessary precautions before and after surgery. Key words: calcaneus, intra articular fracture, open reduction and internal fixation, complication