Open reduction and internal fixation of displaced intraarticular fractures of the calcaneus - influence of type of fracture and congruency of the subtalar joint upon functional result
Abstract
Background: More and more, open reduction and internal fixation (ORIF) followed by early motion are advocated for displaced intraarticular fractures of the calcaneus. In prospective study the author asked, what are the results of ORIF with the calcaneal plate in intraarticular fractures of the calcaneus, and whether type of fracture and/or congruity in the subtalar joint influence these results.
Methods: Forty-three intraarticular fractures of the calcaneus (30 Type II, 10 Type III and 3 Type IV according to Sanders classification) were operated through extensile lateral approach. After reduction of the subtalar joint and restoration of the calcaneus shape, the fracture was fixed with the calcaneal plate. Mostly, surgery was delayed for a few days until soft tissues recuperate. Motion of the ankle and the subtalar joint was encouraged immediately, partial weight bearing after 6–8 weeks and full weight bearing after 3–4 month. After surgery, subtalar joint was found congruent in 33 (77%) and non-congruent (within 2 mm) in ten fractures.
Results: Functional results of 36 fractures with a representative type distribution were evaluated 12 to 61 months postinjury. Functional results were satisfactory in 31 fractures (86%) and not satisfactory in five (14%). All fractures with unsatisfactory results were comminutive (Type III or IV). Four fractures with congruent joint had unsatisfactory, and eight of nine fractures with uncongruent joint had satisfactory result. Statistically, functional results of the comminuted fractures were significantly worse. However, functional results of fractures with non-congruent joint were comparable to the results of fractures with congruent joint and analysis of variance showed that interaction of these two factors was not important.
Conclusions: This prospective study confirms that ORIF enables satisfactory results in majority of displaced intraarticular fractures of the calcaneus. It also confirms that comminution in the subtalar joint is a negative prognostic factor. Furthermore, comminution in the subtalar joint is a negative prognostic factor irrespectless of the postreduction congruity in the subtalar joint, if step-off is less than 2 mm.
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References
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