FAILED PRIMARY TREATMENT OF CALCANEAL FRACTURE. WHAT TO DO?

Abstract

BACKGROUND Many patients are seriously disabled after failed primary treatment of calcaneal fracture.They complain about pain, swelling of the foot and ankle, stiffness and/or limping. Theyhave problems with walking the uneven ground, standing on their toes or climbing ladders.Complains are related to injuries of the soft tissues (not discussed in this paper) and/orinjures of the bones and joints. A decreased Boehler’s angle resulting in flatfoot is notalways a serious defect, and most patients with decreased Boehler’s angle do well, if there isno subtalar arthrosis and/or deformity of the calcaneus. Severe disability is mainly relatedto subtalar arthrosis, mechanical malalignment and impingement (lateral-fibulotalar,anterior- tibiotalar). Any discongruity of the subtalar joint will end in arthrosis of subtalarjoint. However, arthrosis is possible even after complete restoration of the subtalar jointdue to primary cartilage injury. CONCLUSIONS When conservative treatment fails, operative treatment is indicated in most patients withbone and joint problems. The goals of surgical treatment are pain relief and restoration oftalocalcaneal alignment. In lateral impingement, when subtalar joint and general alignmentof the tuber are preserved, removal of the bulged lateral wall could suffice. In suchcases a corrective osteotomy of the tuber is rarely indicated. In painfull subtalar arthrosisfusion is the only option. Limited fusion is preferable. »In situ« subtalar fusion is advisablein cases without malalignment or deformity. When we have arthrosis and varus/valgusdeformity with preserved height, arthrodesis with corrective osteotomy is indicated. In mostcases, where complex deformity is present, corrective subtalar distraction bone-blockarthrodesis should be done