[Surgical treatment of (selected) calcaneal fractures]

The authors present the short-term results of a prospective group of 23 casualties with 28 intraarticular dislocated fractures of the calcaneus who were treated between November 1994 and May 1996 by open reposition and stabilization by means of a plate, supplemented in 22 cases by autospongioplasty. The most frequent complication as regards healing were infections which were recorded seven times, incl. one case with a deep infection, which penetrated to the bone. By subsequent treatment the infection was in all instances cured, the next follow-up period being on average 5.6 months (2-8 months). Metal was extracted in 14 cases, incl. seven cases where it was part of treatment of the infection. For closure of the secondary defect in two instances a microsurgically transferred flap was needed. The patients were followed-up on average for 21 months after the primary operation (6-23 months). A total of 26 calcanei from 21 patients were evaluated. The authors compare two evaluation patterns. According to the authors in 16 instances an excellent result was achieved, a good result in 7 and a poor result in 3 patients. The authors are of the opinion that intraarticular fractures of the calcaneus should be treated by open reposition and stable synthesis. It is not necessary to operate non-dislocated and minimally dislocated fractures, while grossly comminutive fractures should be primarily indicated for arthrodesis. The surgeon must be prepared for the treatment of complications incl. a microsurgical solution of secondary defects.