Fractures of the calcaneum

Sixty-seven patients with 86 fractures of the calcaneum were re-examined 2 to 6 years after their injury. These fractures of the calcaneum were of two types: thalamic, involving the posterior subtalar joint (85%); and nonthalamic, confined to the extra-articular area (15%). Treatment had been by functional therapy, plaster fixation, pin reduction, or open reduction. At followup, only 28 of the 86 heels were entirely painless. Pain was most common posterolaterally along the peroneal tendons; reduction of the tuber (Böhler) angle correlated significantly (p less than 0.001) with an abutment of the peroneal tendons. Motion in the subtalar joint was restricted in two thirds of the series, and in the talocrural joint in one third; a reduction of the tuber angle correlated significantly (p less than 0.001) with reduced mobility of these joints. The duration of sick leave was significantly (p less than 0.05) shorter after functional treatment of displaced thalamic fractures than after treatment with pin reduction and immobilization in plaster. Results were the same with both modes of treatment. The results of treatment of nonthalamic fractures were rewarding, whereas a common consequence of thalamic fractures was considerable impairment of ankle function. The significant correlation between a depressed tuber angle and unsatisfactory functional results suggests that closer attention should be paid to the accurate alignment of the posterior subtalar joint in the treatment of thalamic fractures of the calcaneum.