[Calcaneus fractures. Open reduction and internal fixation].

Area of Science:

• Orthopedic surgery
• Traumatology
• Podiatric medicine

Background:

• Calcaneus fractures are complex injuries requiring precise management.
• Intra-articular involvement significantly impacts functional outcomes.
• Standardized surgical protocols aim to optimize treatment for these fractures.

Purpose of the Study:

• To critically analyze medium-term outcomes of open reduction and internal fixation (ORIF) for displaced intra-articular calcaneus fractures.
• To evaluate the efficacy of a standardized treatment protocol in a large patient cohort.
• To identify factors influencing clinical results after calcaneus fracture surgery.

Main Methods:

• Retrospective analysis of 348 calcaneus fractures in 314 patients treated between 1993 and 1999.
• Focus on 275 displaced intra-articular fractures treated with ORIF, primarily using plate osteosynthesis.
• Postoperative evaluation of 169 patients at a mean of 18 months using questionnaires, physical, and radiographic examinations.

Main Results:

• High functional scores (Maryland Foot Score: 80.8/100, Zwipp score: 146.4/200) achieved in 86% of cases (good to excellent Merle d'Aubigné score).
• Increased infection and necrosis rates observed with open fractures and delayed surgery (>2 weeks).
• Residual steps (>1-2 mm) in the posterior facet and significant loss of Böhler's angle (>30%) negatively impacted outcomes.

Conclusions:

• A standardized ORIF protocol with early mobilization provides reproducible good-to-excellent results for intra-articular calcaneus fractures.
• Minimizing residual steps and optimizing Böhler's angle are crucial for successful surgical repair.
• Emerging techniques like subtalar arthroscopy and percutaneous fixation may further enhance treatment outcomes.