Intra-articular calcaneus fractures. Classification and treatment.
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- Calcâneo; Lesões do Pé; Fracturas Intra-Articulares
lecture / presentation description
Displaced, intra-articular fractures of the calcaneus represent a surgical challenge and the ideal choice of treatment remains a subject of continued debate. The posterior facet of the subtalar joint is involved in almost 90% of all intra-articular calcaneal fractures. Several studies have shown that only anatomic reconstruction of the calcaneal anatomy and meticulous restoration of joint geometry will lead to acceptable functional results. Sanders classification is based on the amount of displaced fracture lines in the posterior facet of the subtalar joint in the coronal CT scans which has been shown to be of prognostic relevance. Open reduction and stable internal fixation has been established as the standard treatment for most of these fractures. Good to excellent results in more than two thirds of patients in larger clinical series. Prognostic factors that can be influenced by the surgeon are anatomical reduction of the overall shape of the calcaneus and congruity of the subtalar joint Systemic contraindications to open reduction and internal fixation include severe neurovascular insufficiency, poorly controlled insulin-dependent diabetes mellitus, non-compliance and severe systemic disorders with immunodeficiency and/or a poor overall prognosis.