Study Of Functional And Radiological Outcomes Of Surgical Treatment Of Displaced Intra Articular Fractures Of Calcaneum: A Prospective Study
Journal Title: International Journal of Orthopaedics Traumatology & Surgical Sciences - Year 2017, Vol 3, Issue 1
Abstract
Background: Calcaneal fractures, irrespective of their types, are treated non-operatively, one of the reasons being fear of complications of surgical intervention. But non-operatively managed fractures can result in equally problematic complications. Incidence of subtalar arthritis in conservatively treated fractures is reported to be 16.9% compared to surgically treated cases with 3.3%.1 With appropriate surgical treatment aimed at achieving anatomical joint reduction, regaining calcaneal height, its length and width, successful attempts at curtailing the long term complications can be made. Methods: Between July 2010 to 2014, 20 displaced intra articular fractures that presented at Victoria hospital and Bowring and Lady Curzon hospital, Bangalore were treated with ORIF with locking calcaneal plates using Fernandez’s3 approach, without use of bone graft. Essex Lopresti4 and Sander’s5 classification were used. Intra operative assessment of reduction and articular surface reconstruction was done under fluoroscopic guidance. Regular follow up was done for assessment of fracture union and complications, assessment of late collapse. Functional assessment was made using Maryland foot score6. The average follow up was 26 months. Results: Among the 20 cases, 85% were males and 15% were females. 10% were intra articular tongue type and 90% were joint depression based on Essex Lopresti classification. Sander’s type 1 and type 4 were excluded. 30% Sander’s type 2, 70% type 3. Near normal anatomic reduction was obtained in all cases except in one where it was difficult due to comminution noted during surgery. Radiological union occurred in 100% percent of cases at an average of 14 weeks. In none of the cases loss of articular reduction, loss of height or varus/valgus malalignment was observed. 1 case of superficial skin necrosis at the surgical site and 1 case of superficial infection and abscess formation were noted at 14th and 30th post operative days respectively. 1 case of early subtalar arthritis was seen at 18th month of follow up. Excellent to good functional results were found in 18 cases (90%), 2 had fair results (10 %). There were no failures as per MFS. Conclusions: Our study shows that the incidence of long term complications can probably be minimized by restoring the altered anatomy through surgical means; hence we advocate surgical management and accurate anatomical reduction in cases of displaced intra articular calcaneal fractures with proper surgical principles.
Authors and Affiliations
P K Raju, Taranath N, Ankith NV, Sachin R, Shivraj N
Keywords
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