Complications of dislocated calcaneal fractures

Calcaneal fractures are the most common of all tarsal fractures, with the majority being the result of high energy injuries causing comminution of bone and lesions of the posterior articular surface. If the bone fragments are left dislocated or non-operative reduction is attempted, the outcome is poor, often with chronic disability. On the other hand, operative treatment does not always lead to a good result and there is an inherent risk of devastating complications.

During a 3-year period (2002-2005) the authors treated operatively (by open reduction and internal fixation) 23 dislocated calcaneal fractures involving the posterior calcaneotalar joint. A control group of 12 patients was treated non-operatively or using minimally invasive techniques. Medium-term results were compared by evaluating the Bohler and Gissane angles and the shape of the posterior calcaneal articular surface on radiographs (lateral and Broden views), while functional outcomes were rated according to the Creighton-Nebraska scale. Complications not included into this scheme were noted.

Both anatomic and functional results were markedly better in the group treated with open reduction and internal fixation. In this group, there were three cases of infectious complications that were attributed to the surgical procedure, while in the other group, two such cases were associated with open fractures. Both groups developed clawing of the toes. The quality of reduction was always unsatisfactory in the non-operative group.

1. Complications of calcaneal fractures significantly worsen the therapeutic outcome. 2. Proper care based on meticulous evaluation of the foot in the early period is crucial for reducing the incidence of complications.