Calcaneal Fractures - Sally Tennant 25/9/2001

Background & History

“Nailing a custard pie to the wall” – Cotton et al 1908

Early 20 ^th century – fixation fraught with technical problems

1935 – Primary Triple arthrodesis advocated – Conn et al

1952 – Essex-Lopresti – defined tongue & joint depression types and refined surgical technique

1958 – Lindsay & Dewar – compared ORIF, primary triple arthrodesisand conservative measures – found best results after conservative management

Recently, CT scanning – improved appreciation of fracture anatomy

Better understanding of wound and fracture healing, peri-operative management and anaesthesia

Producing improved results following surgery

Currently:

Undisplaced (Saunders 1) – Non-operative management

Types 2 & 3 – More amenable to open reduction

Type 4 – Non-operative, or OR and immediate arthrodesis

Factors to consider:

Age of patient

Health status

Soft Tissue Injury

Surgical Experience

Goals of operative management :

1)       Restore Congruency of posterior facet and subtalar joint

2)       Restore height of calcaneus (Bohlers angle)

3)       Decrease width of calcaneum

4)       Decompression of subfibular space available for peroneal tendons

5)       Re-alignment of tuberosity into valgus

6)       Reduction of Calcaneo-cuboid joint if fractured

Surgery

Within 12-24 hours

  Or delay for 10-14 days for ST swelling to decrease

>3/52 – More difficult technically but possible up to 4/52

Approaches:

Lateral

Wide exposure of subtalar joint