Results of functional and surgical treatment of thalamic calcaneus fractures: about a retrospective series of 304 cases

The treatment of thalamic fractures of the calcaneus is often an institutional decision, with no systematic correlation to osteo-chondral lesions. The aim of this retrospective study was to evaluate the results of functional and surgical treatment and to clarify the therapeutic indications based on the thalamic comminution and the position of the thalamic fundamental fracture line. It was a retrospective study conducted between 1990 and 2008. The fracture should involve the subtalar joint with an extension possible at the calcaneocuboid joint. Iinitial CT scans were carried out systematically to analyze the chondral lesions and the dysmorphia of the calcaneus bone. Cases were not included if the Kitaoka score was affected by neurological lesion or musculoskeletal sequela. Two thousand six hundred (and) twenty-four patients or 304 fractures were included. The average time of the revision of results was 39 months. The population was male (78%) with 38% of work-related accident. The treatment was functional in 172 cases, and surgical in 132 cases (89 subtalar arthrodesis with bone reconstruction and 43 osteosynthesis). The parameter "work-related accident" degraded the duration of sick leave and the Kitaoka score regardless of the treatment carried out. Subtalar joint osteoarthritis was present in 90% of cases reviewed. The Kitaoka score was correlated with the reconstruction of the calcaneus bone. It was higher in the group of vertical fractures treated by internal fixation or arthrodesis reconstruction versus functional treatment. Review of the literature confirms the importance of the patient parameters (sex, age, secondary benefit) on the final functional outcome. Surgical treatment has a high rate of complications, which requires a selection of the surgical indications in order to improve the Kitaoka score. The high rate of early secondary osteoarthritis of the subtalar joint, noted in a series of literature, is an important argument to advise a subtalar arthrodesis with calcaneus bone reconstruction immediately if the subtalar joint reconstruction seems impossible. Functional treatment is the best choice for calcaneus fractures, with a global congruency of the subtalar joint. Osteosynthesis seems appropriate for simple fractures with an internal fundamental fracture line associated with a verticalization of a lateral thalamus fragment. Arthrodesis should be reserved for comminuted fractures.