[Treatment of intra-articular calcaneus fracture in the standard care hospital].

A total of 49 intra-articular fractures of the calcaneum were treated from January 1985 to December 1988. In 27 cases the fracture was treated with functional therapy, while in 21 cases management was surgical. The diagnostic procedure was the following: conventional radiography was lateral, axial and dorsoplantar exposures after Böhler. These radiographs allow adequate classification and selection for surgery for the treatment of intra-articular fractures. CT examination is often not available in a general or county hospital, and is not essential for the decision as to whether a conservative or a surgical procedure is more appropriate. Intra-articular fracture of the calcaneum is an indication for surgery except when the bones are totally fractured. We excluded from surgery: 6 patients older than 65 years, 3 with multiple trauma, 2 patients who were receiving coumarin treatment, 3 patients with occlusive arterial disease, and 1 patient who had suffered a cerebral stroke. In 4 cases the patients declined the proposed surgical treatment. Surgery was performed 8 days after trauma. Only lateral incisions were used. We used the Bézes technique, in which bone plate and screw fixation is combined with spongiosa grafting. We observed no necrosis of skin or soft tissue and no infection. Follow-up examination was possible in 33 patients (59% after conservative and 81% after surgical treatment). The patients who had undergone surgery had better results as measured by ability to work, gait pattern and radiological findings of arthrosis.(ABSTRACT TRUNCATED AT 250 WORDS)