Fractures of the calcaneum - A review of 70 patients

We have assessed the long-term results after operative and non-operative treatment of undisplaced and displaced calcaneal fractures. At a mean of 6.5 years, we reviewed 70 patients with a calcaneal fracture who were divided into four groups: group 1, 18 patients with undisplaced fractures and a normal Bohler's angle (BA) who had been treated non-operatively; group 2, 23 with intra-articular fractures and a BA <10degreeswho had been treated non-operatively; group 3, 13 with intraarticular fractures and a BA >10degrees who had been treated surgically; and group 4, 16 with intra-articular fractures and a BA <10degrees who had been treated surgically. The results were assessed by a clinical score considering pain, return to work, return to physical activity, change in shoe-wear and the requirement for subtalar arthrodesis. Patients with undisplaced calcaneal fractures had a good outcome. Those with displaced fractures treated surgically who presented at follow-up with a BA >10degrees had a satisfactory functional outcome and those with displaced fractures who had non-operative treatment had a poor outcome. The poorest outcome was consistently seen in patients who were treated operatively without restoration of BA. Open reduction and internal fixation of intraarticular calcaneal fractures can only be expected to benefit those patients in whom nearly anatomical reconstruction is obtained.