Correction Loss of Calcaneal Fractures by Different Type of Osteosynthesis

PURPOSE OF THE STUDY The calcaneal bone is affected in 2% of body fractures. Because of its major influence to walking stability with its permanent consequences affecting both daily living and work activities, huge effort is expended on suitable treatment of these fractures. Many studies have focused on surgical treatment of calcaneal fractures or on comparing operative and non-operative treatment. The aim of this retrospective study is to investigate stability of different type of osteosynthesis. MATERIAL AND METHODS This study involves 119 men and 24 women aged 20 to 84 years who were in the period from 2011 to 2015 surgically treated for broken calcaneus in the Trauma Hospital in Brno - this study covers 152 calcaneal fractures in 143 patients. The calcaneal fractures were classified into Sanders I-IV subgroups based on the CT scans and divided by the applied type of osteosynthesis. The Bohler and Gissane angle as well as height, width and length of calcaneal bone at the time after reposition and stabilization and at 3 and 12 months after the trauma were compared. Also tracked was the relationship between the imaging scans and the clinical assessment based on the AOFAS Ankle-Hindfoot Scale (A-H score). RESULTS Decrease of the Bohler angle (increment of the Gissane angle) of more than 5 degrees and reduction of height and extension of length or width of the calcaneal bone of more than 2 mm were defined as a criterion of osteosynthesis failure. These conditions were met in 53 surgically treated calcaneal fractures (35% of the total). In 17 cases the angular stable plate failed (it is 36% of the used plates), in 21 cases it was the C-nails (42%) and in 11 cases the screws (24%) that failed. In this group, 20 patients (38%) were satisfied with 100 points in the A-H score, 16 patients (30%) felt good, 11 patients (21%) quite good and 5 patients (9%) felt bad. DISCUSSION It is difficult to compare the stability of different types of osteosynthesis in a retrospective study because of the compliance impossibility, differences in the follow-up time and distortion of X-rays. The results are distorted in uncooperative patients, smokers, alcohol abusers and in elderly patients. CONCLUSIONS The stability of different types of osteosynthesis is almost equal - the most stable is the screw synthesis (24% probability of failure), the plates show 36% odds of failure, and the most unstable seem to be the C-nails with 42% probability of failure. However, these results do not correlate with the clinical conditions according to the A-H score.