Treatment of os calcis fractures by open reduction and internal fixation

Over a 3-year period, 47 displaced intra-articular fractures of the os calcis in 43 patients underwent open reduction and internal fixation. A significant feature of this series is that computed tomography was used to assess all fractures both before and after surgery. Seventy-seven percent demonstrated a consistent fracture pattern with four major bone fragments. Patients underwent clinical assessment 1 year after injury; thirty-six feet (76.6%) were rated satisfactory and 11 (23.4%) were rated unsatisfactory. An unsatisfactory clinical outcome was significantly correlated with failure to obtain or maintain a satisfactory reduction (P = .004) and also with workers' compensation or liability status (P = .013). The degree of initial comminution, bilateralism, calcaneocuboid joint involvement, patient age, joint depression versus tongue-type fracture pattern, and Bohler's angle at follow-up did not correlate with the final clinical result. Postoperative computed tomography in the coronal plane was found to be mandatory for assessment of joint congruity and restoration of an adequate fibulocalcaneal space.