The os calcis that is the largest tarsal bone has most frequent incidence of fracture than any other tarsal bones. Extra-articular fractures of the calcaneus can be expected to heal rapidly and leave the patients with mimimal morbidity. However, intra-articular fractures involving subtalar joint are associated with long term disability. There is a great deal of controversy regarding treatment of intra-articular fractures of the calcaneus involving subtalar joint.
The object of this study is to know relationship between the fracture pattern. methods of treatment and clinical results. and especially to assess clinical significans of restoration of Bo¨hler angle in displaced intra-articular fractures of the calcaneus.
From January 1985 to December 1990, forty-nine cases of calcaneal fracture in 43 patients who were treated at Department of Orthopaedic Surgery, Korea Universty Hospital were analyzed in clinical and radiologic aspects. The minimal follow up was one year.
Twenty-nine patients were male and fourteen were female. The most common age distrbution was 5th and 6th decade in twenty-four patients (55.8%). The most common cause of injury was a fall from height in thirty-eight patients (88.4%). The most common associated injury was spine fracture in nine cases (18.4%) out of forty-nine cases. There were type 1 in one case. type 2 in two. type 3 in nine, type 4 in six and type 5 in thirty-one according to Rowe’s classification. Among 31 cases of Row’s type 5, there were tongue type in sixteen cases and joint depression type in fifteen according to Essex-Lopresti’s classification. The methods of treatment were closed reduction and axial pinning in thirty-four cases. long leg cast immobilization in eleven. open reduction and internal fixation in three. and triple arthrodesis of the foot in one. The avarage Bo¨hler angles were changed from 20.5 degrees to 30.5 degrees in Rowe’s type 4. from 1 degree to 23.5 degrees in tongue type and from 6.3 degrees to 24 degrees in joint depression type after operation.
The results obtained were as follows :
1. The clinical results were excellent in twenty-one cases, good in thirteen, fair in thirteen, and poor in two by criteria of Salama et al.
2. The clinical results according to fractures type were excellent or good in all twelve cases of extra-articular fractures of Rowe’s type 1,2 and 3, and excellent or good in twenty-two cases among thirty-seven cases of intra-aricular fractures involving subtalar joint of Rowe’s type 4 and 5.
3. The clinical results according to methods of treatment were excellent or good in twenty-one cases among thirty-four cases treated with closed reduction and axial pin fixation, in nine cases among eleven cases with long leg cast immabitization, and in all four cases of open reduction or triple arthrodesis.
4. Better results were taken from tongue type contrast to joint depression type at closed reduction and axial pinning.
5. The avarage Bohler angle according to clinical results were 31.7 degrees in excellent, 26.2 degrees in good, 22.0 degrees in fair and 13.8 degrees in poor.
6. The most common complication was pain around the ankle joint in sixteen cases (32%).
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