Treatment of Late Complications of Intra-Articular Calcaneal Fractures

The late complications of intra-articular calcaneal fractures are related to the possible degeneration of the subtalar joint and to the entire complex deformation produced at the moment of the injury. The acute treatment therefore must minimize the possibility of secondary problems, and reconstruction must re-establish the overall shape of the calcaneus bone. The most relevant problem inherent in calcaneus fractures is the axial deviation of the calcaneus on its frontal, horizontal, and (less frequently recognized) sagittal planes. The sagittal deviation contributes to the functional limitation of the tibiotalar joint and can cause the painful syndrome of distal tibiofibular syndesmosis. Other possible secondary problems are nerve branch compression (tibialis or sural nerves), fibulo-calcaneal bone impingement, plantar osseous protrusion, and toe retraction. All these problems, in isolation, combination, or in association with painful rigidity of the subtalar joint, were seen in varying degrees in the patients for whom data are presented in this article. Surgical treatment of late complications of calcaneal fractures represents a problem with highly uncertain results, although the surgical stabilization of the subtalar joint, in absence of other problems, is easy to establish.