Calcaneal intra-articular fracture osteosynthesis: Clinical and radiological prospective study of 31 cases

Osteosynthesis for calcaneal fractures remains controversial. We osteosynthesize all displaced intraarticular fractures, the only contraindications regarding age, local and arterial status, or non-compliance. We here report a prospective study of 31 calcaneal articular fractures, with a mean 4.5 years follow-up. Following CT scan, patients were operated at a mean 6.1 days with the same surgical (single surgeon-extended lateral approach) and post-operative protocol. On Sanders' classification, there were 18 type II, 8 type III, and 5 type IV fractures. Twenty-six patients had clinical and comparative standard X-ray follow-up; 19 also had CT assessment. Two complications needed repeat surgery: one limited skin necrosis, one infected hematoma. Fifty-eight % were very satisfied, and 42% satisfied; 77% returned to work. Mean Kitaoka score was 86.2. Tibiotarsal motion was normal, and subtalar motion 45%. X-ray confirmed anatomical reconstruction: no joint reduction defect; medial arch angle, calcaneal pitch, calcaneal soft-pad thickness, and calcaneus height, length and width subnormal. Mean Boehler angles were: 6.6° preoperatively, 32.3° postoperatively, and 27.1° on follow-up for injured vs. 32° for non-injured foot. Thirty-six % had posterior subtalar remodeling on standard X-ray, and 79% on CT scan, without correlation with functional results or radiological type. Due to calcaneal posterior facet height loss, we recommend 10 weeks' non-weightbearing. These good results match the literature, generally indicating surgery for displaced calcaneal intraarticular fractures