Sanders type IV intra-articular calcaneal fractures remain among the more challenging fractures for the orthopedic surgeon to manage. There is a great debate about the best type of treatment of Sanders type IV fractures, which varies from non-operative treatment to operative treatment which entails either ORIF alone or ORIF combined with a primary subtalar arthrodesis. This study was performed on 12 sanders type IV intra-articular calcaneal fractures. 10 of them were males (83.3%) and 2 of them were females (16.6%). The study was performed between July 2005 to July 2009in different centers with a follow up period 9-48 months with an average 28.5 months. Operative procedure was done through using the extended lateral approach, restoring the normal calcaneum geometry (height, length, broadening and valgus position), lateral neutralization plate& screws and primary subtalar arthrodesis by using autogenous iliac crest cancellous bone graft fixed in situ by one or two 6.5mm cannulated or cancellous screws. The functional results were ranging between 54-76 points with an average 70.3 point according to Creighton-Nebraska health foundation assessment score for fractured calcaneum. Complications met in this study were: fracture blisters in 3 cases (25%), superficial wound infection in 2 cases (16.6%), peroneal tendonitis in 4 cases (33.3%), accompanied foot joints arthritis in 6 cases (50%) and reflex sympathetic dystrophy in 5 cases (41.6%). It was concluded that ORIF accompanied by primary subtalar arthrodesis is a useful type of management for Sanders type IV calcaneal fractures. |
