Abstract

• The treatment modality of the displaced intraarticular calcaneal fractures is still controversial. The objectives of this study are to classify intraarticular fractures based on computed tomography and to compare the treatment results according to the classification and to consider the influence of Bohler angle to the prognosis of this injuries. From October 1989 to March 1997, 62 fractures(58 patients) who had been treated after calcaneal CT(computed tomography) were selected. The interval between the trauma and the last follw-up was mean 3.3 years(1.1-5.2 years). They had been treated with one of the three methods, that is, open reduction and internal fixation(OR/IF), Essex Lopresti or simple cast immobilization. The fracture was classified as type I(non-displced), type I(two part or split), type III(three part or split depression), type IV (four part or highly comminuted) based on CT according to Sanders et. al. The calcaneal scoring system proposed by Kerr et. al. was applied to the assessment of the treatment results, which may be more appropriate for non-parametric statistical test. The type I fractures had been treated only with cast immoobilization with or without manual reduction and all of the 4 cases(100%) have shown favorable(excellent or good) results. The OR/IF group(favorable results for 15 of 18 cases(83.3%) in type II and for 11 of 13(84.6%) in type III) have shown better results than those of other two group(P<0.05). The results between other two groups, that is, Essex-Lopresti operation group(favorable results for 4 of 8 cases(50%) in type II and for 1 of 3(33.3%) in type III)and cast immobization(2 of 5 cases(40%) in type II and for 0 of 2(O%) in type III) have made no significant differences(p>0.5). In type IV, there were no significant differences among the results of the three methods(p>0.1) and worse results than type II, III (p <0.05) probably due to difficulty in reduction of highly comminuted articular facets. The Bohler angle has given no significant influence to the final results(p>0.1). In conclusion, OR/IF has shown better results than closed modalities in the treatment of displaced intraarticular calcaneal fractures and may be the primary choice of treatment for these fractures. We have used Kruskal-Wallis H test and its approximation to chi-square distribution for comparison of three groups and Mann-Whitney U test and its approximation to normal distribution for two groups and have been aided by the computer program, SPSS in statistical calculations. The p-value was 0.05.
• Key words: Calcaneus, Intraarticular Fracture, Bohler angle, Computed Tomography

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