Osteosynthesis for intra-articular calcaneal fractures

Purpose.To correlate treatment results of intra-articular calcaneal fractures with their computed tomographic (CT) classification.Methods.36 men and 4 women with 48 intra-articular calcaneal fractures (8 bilateral) underwent open reduction and internal fixation with bone grafting via an extensile lateral approach. Based on 2-dimensional CT scans, the fractures were categorised using the Sanders classification. There were 16 type-II, 20 type-III, and 12 type-IV fractures. Radiographs and Maryland foot scores were used for evaluation of the results at a mean of 38 (range, 26–66) months.Results.Anatomic reduction of the posterior calcaneal facet was achieved in 38 of 48 fractures. The Bohler and Gissane angles were restored to between 92 and 99% of normal, respectively. Despite this, the mean functional scores were 84 in type-II, 83 in type-III and 67 in type-IV fractures.Conclusion.Surgical results were superior in type-II and -III fractures. Type-IV fractures fared poorly, despite excellent restoration of calcaneal anatomy; subtalar arthrodesis should have been considered.