Displaced Intra-articular Fractures of the Calcaneus: with an emphasis on minimally invasive surgery

Displaced intra-articular calcaneal fractures are complex injuries. Classically these fractures are treated with open reduction and internal fixation (ORIF) or conservatively. When comparing these two treatment modalities, ORIF has a significantly higher rate of wound complications and conservative management has a significantly higher rate of secondary fusions. Therefore a minimally invasive surgical procedure was introduced at the Erasmus MC in 1998, combining the benefits of both techniques. The aim of this thesis was threefold: 1. To set a basis for improved translatability of outcome in future trials. 2. To determine the outcome of percutaneous reduction and internal fixation using the modified method of Forgon and Zadravecz. 3. To determine the best practice for delayed complications after displaced-intra-articular calcaneal fractures. Important conclusions were: 1. Uniformity in treatment of intra-articular calcaneal fractures More uniformity can been obtained in the evaluation of displaced intra-articular calcaneal fractures. The classification systems by Crosby and by Sanders are the most frequently applied out of the 64 available fracture classifications, and show the best interobserver agreement. The standard radiographs show little correlation with outcome. Out of 34 different outcome scoring systems the AOFAS and the MFS are the most useful. 2. Percutaneous treatment of intra-articular calcaneal fractures Minimal invasive surgery, according to Forgon and Zadravecz, for displaced intra-articular calcaneal fractures, provides overall good to excellent result in 71 to 90% of patients. 3. Management of late complications In case of persistent complaints a subtalar arthrodesis provides equal results compared to a triple arthrodesis. Smoking was a definite risk factor for a failing arthrodesis.

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