Fractures of the calcaneum: when and how to operate

Between the years 1967 to 1984, 307 fractures of the calcaneum were treated by different methods, 148 of which were available for long-term review. These have been studied in three groups; those treated conservatively (42), those treated by the Essex-Lopresti method (34) and the present group of 72 cases treated by a variety of surgical methods. These have been analysed with a view to ascertaining whether it is possible to propose a best type of operative treatment related to the type of fracture according to the AO system of classification. From a detailed review of the failures, it emerges that the greatest problem is posed by fractures involving the posterior articular surface with downward displacement of one of the fragments, and by burst fractures of B3 types 1, 2 and 3 (AO classification). From this review, it emerges that the best methods of treatment are as follows: for B3.2 fractures characterised by vertical sinking, the open or closed Essex-Lopresti method of repositioning; for B3.2 fractures characterised by horizontal sinking, open repositioning and osteosynthesis; for B3.3 fractures, in which there is complete disruption of the articular surface, arthrodesis by the Stulz method in the best position obtainable.