title: Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases.
abstract: We carried out a retrospective review of 47 intra-articular fractures of the calcaneum treated by open reduction and internal fixation in 45 patients by a single surgeon between 1993 and 2001. The fractures were evaluated before operation by plain radiographs and a CT scan using Sanders' classification. Osteosynthesis involved a lateral approach and the use of the AO calcaneal plate. The mean follow-up was for ten years (7 to 15). Clinical assessment included the American Orthopaedic Foot and Ankle Society Score (AOFAS), the Creighton-Nebraska Score, the Kerr, Prothero, Atkins Score and the SF-36 Health Questionnaire. The radiological evaluation consisted of lateral and axial views of the os calcis. Arthritic changes in the subtalar joint were assessed with an internal oblique view and were graded using the Morrey and Wiedeman scale. There were 18 excellent (38.3%), 17 good (36.2%), three fair (6.3%) and nine poor (19.2%) results. Five patients had a superficial wound infection and five others eventually had a subtalar arthrodesis because of continuing pain. Restoration of Böhler's angle was associated with a better outcome. The degree of arthritic change in the subtalar joint did not correlate with the outcome scores or Sanders' classification. Prompt osteosynthesis should be considered for intra-articular fractures of the calcaneum in order to restore the shape of the hindfoot and Böhler's angle.
authors.affiliation: Department of Trauma and Orthopaedics Princess Alexandra Hospital, Hamstel Road, Harlow CM201QX, UK. daoudmakki@hotmail.com
authors.forename: D
authors.initials: D
authors.lastname: Makki
authors.forename: H M
authors.initials: HM
authors.lastname: Alnajjar
authors.forename: S
authors.initials: S
authors.lastname: Walkay
authors.forename: U
authors.initials: U
authors.lastname: Ramkumar
authors.forename: A J
authors.initials: AJ
authors.lastname: Watson
authors.forename: P W
authors.initials: PW
authors.lastname: Allen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006801:Humans; D057072:Intra-Articular Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000453:epidemiology; D017060:Patient Satisfaction; D020127:Recovery of Function; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013380:Subtalar Joint / Q000000981:diagnostic imaging / Q000601:surgery*; D013530:Surgical Wound Infection / Q000453:epidemiology; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome