title: The primary arthrodesis for severely comminuted intra-articular fractures of the calcaneus: a systematic review.
abstract: BACKGROUND
  Although open reduction and internal fixation via the extended lateral approach is currently considered gold-standard, severely comminuted calcaneal fractures might not be amendable for reconstruction. The primary aim of the current review study was to assess the functional outcome of the primary arthrodesis in the management of comminuted displaced intra-articular calcaneal fractures.
  
  
  METHODS
  The literature was searched for studies published between January 1st 1990 and December 1st 2010, to identify studies in which a primary arthrodesis was utilized for the treatment of displaced intra-articular calcaneal fractures between. The methodological quality of the included studies was assessed using the Coleman Methodology Score.
  
  
  RESULTS
  Seven case series and one abstract were identified, reporting on 120 patients with 128 severely comminuted calcaneal fractures. Average follow-up time was 28 months and union rate 97%. Functional outcome was assessed using the modified AOFAS score in seven studies; with a weighted average of 77.4 (range 72.4-88). One study reported a 75% good to excellent outcome on the Paley score. Three studies reported on return to work, ranging from 75 to 100%. Overall reported wound complications occurred in 19.4%. The average Coleman Methodology Score was 56 (range 38-68) points.
  
  
  CONCLUSIONS
  The primary arthrodesis for the treatment of Sanders type-IV comminuted displaced intra-articular calcaneal fractures provides overall good results considering the severe nature of the injury. Therefore, in the process of choosing the best treatment modality for a severely comminuted calcaneal fracture, the primary arthrodesis should receive full consideration.
authors.affiliation: Erasmus MC University Medical Centre, Department of Surgery-Traumatology, Room H-822k, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. t.schepers@erasmusmc.nl
authors.forename: T
authors.initials: T
authors.lastname: Schepers
mesh_terms: D001174:Arthrodesis; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery*; D018460:Fractures, Comminuted / Q000601:surgery*; D006801:Humans; D015601:Injury Severity Score; D057072:Intra-Articular Fractures / Q000601:surgery*