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Abstract The calcaneus is the largest of the tarsal bones. It is irregularly cuboidal and designed to withstand the daily stresses of weight bearing. The calcaneus have architecture much like an egg; hard on the outside and very soft in the center. And just like an egg, the calcaneus is very susceptible the crush injuries. Its anterior half supports the talus. The later, in turn, carries the whole body load through the tibia. The calcaneus serves a dual purpose: it provides an elastic, firm support for the weight of the body and also functions as a spring board for locomotion. Axial loading is responsible for the majority of intraarticular calcaneal fractures. Usually, the axial load results from a fall from a height. Any fall – even a short one – may result in fracture as the talus is driven downward into the calcaneus. Twisting forces and avulsive forces cause many of the extraarticular fractures. Many attempts have been made to classify fractures of the calcaneus, however, no single classification system has been completely satisfactory. For clinical use, the Essex-Loperesti classification is the simplest, but it provides no framework for determining surgical strategies or determining the long term outcome divided calcaneal fractures into two main categories: extra-articular and intra-articular fracture. The classification of Sanders et al. has the advantage of enabling outcome prognostication and that of Zwipp et at. offers the best way to describe the typically complex pattern of calcaneal fractures. Clinical and radiological examinations are essential for any patient with calcaneal fractures to exclude fracture of the spine or similar injury to the other foot. For any patient who complain of An evaluation version of novaPDF was used to create this PDF file. Purchase a license to generate PDF files without this notice. Summary 105 hind foot pain after an injury, the basic radiographic examination should include all the standard and oblique views to diagnose the location and degree of severity of calcaneal fractures. The CT scanning which can demonstrate the anatomy of the subtalar joint in several planes with minimal positioning of the patient and give excellent visualization of the articular facets, combined with conventional lateral and axial views defines precisely the making. MRI allowed excellent detailed visualization of the calcaneal fat bad and surrounding structures. The appropriate care of calcaneal fracture continues to be an unresolved dilemma and the history of treatment is characterized by periods of enthusiasm for surgical intervention followed closely by periods of advocacy of closed treatment methods. While there is little disagreement surrounds the treatment of extra-articular fractures of the calcaneus with good results in the majority of cases, significant controversy remains over the results of non-operative versus operative treatment for the intra-articular fractures of the calcaneus. There are numerous advocators of non-operative treatment and early mobilization of intra-articular fractures, but the recent literature indicates that open reduction and internal fixation (with or without bone graft) within 10 days of injury yields the most satisfactory results. Many surgeons still treat calcaneal fractures nonoperatively, either because of a lack of familiarity with the operative techniques or because they fear the operative complications. The skin complications resulting from extended lateral approach such as wound infection and skin dehiscence that these complications are near nil in limited ORIF of intra-articular fractures of the calcaneum. An evaluation version of novaPDF was used to create this PDF file. Purchase a license to generate PDF files without this notice. Summary 106 Intra-articular fractures of the calcaneus should be treated as fractures of the major weight bearing joints with anatomical reduction, rigid fixation and early mobilization. Immediate open reduction and internal fixation is not recommended because of the soft tissue compromise, and delayed procedures are the rule. Most authors consider 7th to 9th post truama day to be sufficient for soft tissues to resolve. Use bone grafts in the persistence of a large cortical defect after reduction of the lateral calcaneal wall. We can decrease the incidence of wound problems by using a limited lateral approach patients selection (Sanders type IV is excluded), stop smoke until the wound has healed, perioperative antibiotics, a tension-free closure utilizing suture techniques to the skin is essential, drains to prevent hematoma formation postoperatively, sutures should be left in place for 3 weeks, and avoid motion exercises until wound has healed. Post operative rehabilitation is contributed to the very good results. |