Author/Editor		Andoljšek, M
Title		Failed primary treatment of calcaneal fracture. What to do?
Translated title		Misslungene Erstbehandlung von Kalkaneusfrakturen. Was ist zu tun?
Type		članek
Source		Orthopaedische Praxis
Vol. and No.		Letnik 41, št. 4
Publication year		2005
Volume		str. 188-91
Language		eng
Abstract		Many patients are seriosly disabled after failed primary treatment of calcaneal fracfure. They complain of pain, swelling of the foot and ankle, stiffness and/or Iimp.They have limitations in walking on uneven ground, standing on fhe toes or climbing ladders. Complaints are related to injuries of the soft tissues (not discussed in this paper) and/or injuries of the bones and joints. A decreased Boehler's angle resulting in flatfoot is not always a serious defect, and most patients with decreased Boehler's angle do well, if there is no subtalar arthrosis and/or deformity of the calcaneus. Severe disability is mainly related to subtalar arthrosis, mechanical malalignment and impingement (lateral-fibulofalar, anterior-tibiotalar). Any discongruity in the subtalar joint will end in arthrosis of subtalar joint, however, arthrosis is possible even affer complete restoration of the subtalar joint due to primary cartilage injury. When conservative treatment fails, operative treatment is indicated in most patients with bone and joint problems. The goals of surgical treatment are pain relief and restoration of talocalcaneal alignment. In lateral impingement, when subtalar joint and general alignment of the tuber are preserved, removal of the bulged lateral wall could suffice; rarely corrective osteotomy of the tuber is indicated in such cases. In painful subtalar arthrosis fusion is the only option. Limited fusion is preferable. "In situ" subtalar fusion is advisable in cases without malalignment or deformity. When we have arthrosis and varus/valgus deformify with preserved height, arthrodesis with corrective osteotomy is indicated. In most cases, where complex deformity is present, corrective subtalar distraction boneblock arthrodesis should be done.
Descriptors		CALCANEUS ANKLE INJURIES FRACTURE FIXATION OSTEOTOMY ARTHRODESIS TREATMENT OUTCOME