الفهرس 
AcknowledgementOnly 14 pages are availabe for public view
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Abstract
Calcaneus fractures are a significant burden to the society. Assessment and treatment of these injuries has improved significantly over the past two decades with the use of the CT scans. It has allowed us greater understanding of the pathological anatomy of these fractures, and has provided us with a prognostic classification system with respect to outcome.
Non-operative treatment is effective for fractures that are nondisplaced or minimally displaced (<2mm). Open reduction and internal fixation is the standard therapy for fractures that are displaced greater than 2mm, with a 65-80% good to excellent results in different literatures.
To obtain these results, the soft tissues always must be respected. Compartment syndrome always should be ruled-out clinically, and open fractures should be treated aggressively.
Open fractures, compartment syndrome and fractures with severe soft tissue compromise are emergencies.
An extended lateral approach respects the local anatomy (neurovascular supply) of the heel, and provides the best opportunity to restore the congruity of the joint surface, fractured lateral wall, and calcaneo-cuboid joint in complex fractures. It also provides a room for lateral plating osteosynthesis.
Anatomic restoration of the articular surfaces and restoration of the original shape of the calcaneus (Bohler`s angle) are of prognostic value.
This measures can be assessed intra-operatively, with the Harris axial view, the lateral ankle view, and the Broden`s oblique view with the intra-operatively fluoroscopy.
Fixation was performed by different types of plates and screws. Special calcaneal plates showed a higher satisfactory rate than other plates. In the vast majority of the cases, bone grafting was found to be not necessary.
Satisfactory outcome was related to the fracture classification type, and the type of fracture reduction. Sanders Type II always has a better score than in Type III, IV. Anatomic reduction is always accompanied by a high satisfactory score.
Patients who had severely comminuted fractures (Sanders Type IV) can be treated with open reduction and internal fixation to restore the anatomy of the calcaneus as exact as possible, and if symptoms are persistent, an easily arthrodesis will be done.
Conclusion
Intra-articular calcaneal fractures are severe injuries with long-term effects on function. Open reduction and internal fixation of displaced intra-articular calcaneal fractures is an effective method of treatment.
Comminution and displacement of the posterior facet of the subtalar joint appears to be important prognostic factor. If operative treatment is chosen, reduction of both the articular and non-articular components of the fracture must be as exact as possible to obtain superior results than obtained in closed treatment.
The extensile lateral approach and the plate fixation are recommended, however, this surgery is very challenging with surgeon dependant learning curve. The operation requires a surgeon who is experienced in osteosynthesis of fractures to get the best results.
Satisfactory results can be expected after open reduction and internal fixation in Sanders Type II, III fractures. In Type IV fractures, open reduction and internal fixation should be attempted first to restore the calcaneal shape, anatomy and the subtalar joint. Even if subtalar arthritis eventually occurs in a latter stage, it would be easier to perform joint fusion and the end results would be more acceptable.
Bone graft is not necessary to maintain reduction.
The outcome is directly correlated with anatomic reduction and stable internal fixation of the displaced articular fragment of the posterior face.