Accurate anatomical reduction, rigid internal fixation and early mobilization are essential for good prognosis especially in the intraarticular fractures. Fractures of the calcaneus involving the subtalar joint have controversy for treatment
method
because of the anatomical complexity and hence difficulty of accurate reduction and rigid internal fixation.
We analyzed 26 cases (15 males, 6 females) of the calcaneal fractures involving the subtalar joint, which were treated by open reduction and internal fixation from May, 1992 to Feb., 1995 in Asan Medical Center. The average follow-up period was
18.3
months ranged from two to forty three months.
According to the Essex-Lopresti classification, there were 12 cases of joint depression type, 11 cases of tongue type, and 3 cases of comminuted type. In 10 cases which were evaluated with CT scan, there were 4 cases of type II, 4 cases of type
III, and
2 cases of type IV according to the Sander's classification.
We used the extensive lateral approach and applied cervical H-plate or reconstruction plate in most cases for internal fixation.
The results of the treatment were obtained as followed; Bohler angle was recovered on the average 27.0° from -3.5° preoperatively to 23.5° postoperatively; Gissane angle, 0.5° from 119.1° to 119.6°; the height of heel, 19% to 96% and the
width of
the calcaneus was reduced 16% to 105% of contralateral one respectively. The functional results of operation were good or excellent, but those of severely comminuted type were unsatisfactory.
We concluded that the fractures of the calcaneus are still unsolved problem, but should be managed in the principle of the treatment of the intraarticular fracture, and this can be done throght the extensive lateral approach with ease and safe.
|