Surgical treatment of calcaneal fractures

Overview

INTRODUCTION:
This paper deals with intra-articular calcaneal fractures and their surgical treatment. The introduction includes an overview of theoretical knowledge. This is followed by the results of observations made over the period 2005-2014 of the surgical treatment of patients. The observations include Böhler angle evaluations prior to and after surgical treatment. The post-operative Böhler angle value was then compared to osteosynthesis performed under the MIOS (mini-invasive osteosynthesis) and ORIF (open reduction internal fixation) methods. Any complications in either type of osteosynthesis are listed.

Objective:
To evaluate the post-operative Böhler angle and subsequent complications of osteosynthesis performed by MIOS and ORIF methods.

Material:
In the period 2005-2014, 60 patients with fractures of the calcaneus were operated on, of which 48 (80 %) men, 11 (18.8 %) women and one child. The male: female ratio was therefore 5:1. Bilateral fractures occurred in three patients (5 %), closed fractures in 59 (98.3 %) patients, and an open fracture in one patient. The average age of the patients that were operated on was 39.5 years. The youngest child was 12 years old, the oldest man was 78 years of age.

Discussion:
The treatment of calcaneus fractures and determining the type of osteosynthesis is difficult. There are many studies supporting both the MIOS and ORIF treatment methods. The diversity of opinions on surgical treatment is based on the existence of many variables (patient characteristics, character of the fracture lines, etc.) which are included in the selection of the type of osteosynthesis.

Results:
The quality of the reduction after surgery was verified by assessing the Böhler angle. The average Böhler angle prior to surgery was 6.8 degrees (1.2 degrees minimum – 18.3 degrees maximum). The mean angle measured postoperatively was 28.4 degrees (19.2 degrees minimum - 35.5 degrees maximum). In Sanders II, III and IV fractures, the mean post surgery Böhler angle was 32.5 degrees, 27.9 degrees and 22.1 degrees respectively. The mean Böhler angles were also calculated after MIOS and ORIF osteosynthesis and were found to be 21.8 degrees and 25.1 degrees respectively.

Conclusion:
The goal of the surgical treatment of calcaneal fractures is to restore the anatomy of the subtalar joint. The ORIF method enables the better visualisation and reduciton of the subtalar and calcaneocuboid joints, but with the increased risk of soft tissue healing disorders. The opposite is true of the MIOS method, it protects the soft tissue, but it is more difficult to achieve accurate reduciton. Fractures with significant damage of the articular surfaces are difficult to treat. Under these circumstances, even when utilising the ORIF method, it is difficult to achieve accurate reduciton. The question therefore remains whether these fractures can be treated by primary osteosynthesis or primary subtalar arthrodesis.

Key words:
intra-articular calcaneal fractures, ORIF, arthroscopy, arthrodesis, leg compartment syndrome.