Operative Treatment Algorithm for Intra-articular Calcaneal Fractures


individual therapeutic concept; calcaneal fractures; ORIF; plate osteosynthesis; minimally invasive osteosynthesis

Published online: Dec 30 2018

Vladimír POPELKA, Radoslav ZAMBORSKY

From the Department of Orthopedics, Faculty of Medicine, Comenius University and Children's  University  Hospital, Bratislava, Slovakia


Displaced calcaneus fracture often results in severe permanent sequelae and considerably limits the activities of daily living. In this prospective cohort study we present the outcomes of surgical treatment of 137 displaced intra-articular calcaneal fractures, over 8y period. Follow-up data were obtained up to 3 years post-operatively.

Post-operative function was assessed by scoring systems - Creighton-Nebraska Health Foundation Assessment Scale (C-N score) and Ankle-Hindfoot Scale AOFAS (A-H score) and radiographic assessment revealed the accuracy of the position. According to our experience we could advocate percutaneous reduction and screw fixation as the method of choice for Sanders type IIC tongue-type fractures and modified Palmer approach with screw alone, C-nail, K-wires or alternatively an open plate osteosynthesis in Sanders type IIAB depression fractures. For Sanders Type III fractures, we find ORIF with a plate as the most suitable method and an external fixation supplemented with K-wires for Sanders Type IV.