Calcaneus fractures

Abstract

Introduction. Calcaneus fractures are the result of high energy trauma, falls from height, road accidents. Calcaneus fracture constitutes 60% of the Tarsian fractures, 75% of them are intraarticular and represent 2% of the total fractures, more commonly happens with men between 21-45 years (90%). Aim of the study. The study of contemporary literature with reference to the treatment of calcaneus fractures with the purpose to assess the treatment strategy. Materials and methods. There were 28 literary sources, articles and scientific papers studied. Results. Signs of calcaneus fractures are: deformation of the calcaneous region accompanied by its widening transversely, deletion of the malleolar reliefs and of the Ahilian tendon, flattening of the plantar arch and the "numeral" ecchymosis in the plantar area, mobility in the ankle joint is diminished. The degree of movement of the fragments depends on the kinetic energy of the trauma. The evaluation of a calcaneus fracture begins with radiography in 2 projections, anterior-posterior, with the calculation of the Bohler and Gissan angle and the axial projection (Harris). Bohler classification (usually 20-40) is a criterion for assessing the severity of the fracture. The gold standard in the diagnosis of calcaneus fractures is the computed tomography using the Sanders classification and in case of lack of CT examination the Broden projections are made. Treatment depends on the anatomical-clinical form of the fracture. Orthopedic treatment is indicated for fractures without displacement, as well as for the thalamic (Sanders I) and for the extratalamic ones. Graffin type gypsum immobilization is done if the soft tissues allow. f not, the foot will be put in a prone position with the mobilization of the fingers and ankle joint from the first days. Percutaneous osteosynthesis with cannulated screws is indicated for extratalamic fractures. Surgery is indicated for thalamic fractures Sanders IIIIV - open reduction and osteosynthesis with plate and screws. The optimum time for surgery is in the first 3 weeks and when the "Wrinkle" test is positive. The outcome of the surgical treatment as well as the orthopedic treatment is influenced by the factors related to the patient (diabetes, peripheral vascular disease, obesity, smoking, the elderly, late addressing, serious injuries associated) as well as the path of the fracture. Conclusions. Patients with calcaneus fracture treated surgically have a shorter rehabilitation period compared to those treated orthopedic. The functional result is better when the Bohler angle and the anatomical reduction is restored.