Extensive Intraarticular Fractures of the Foot

Periodic cycles of enthusiasm for surgical management characterize the history of fractures of the calcaneus of the past century. After each period of advocacy for aggressive surgical therapy, there has been a trend toward nonoperative treatment. Morbidity and disappointing results were reported by those whose early attempts at open reduction were more difficult than expected. With the emergence of a subspecialty within orthopedic surgery devoted to fracture care, the pendulum has again swung toward operative treatment. A clearer understanding of fracture patterns from cross-sectional imaging, concentration of the injuries in the care of experienced fracture surgeons, perioperative antibiotics, rigid internal fixation, and early rehabilitation represent the latest attempts to improve the outcome from this vexing injury. Using an extensile lateral approach, rigid internal fixation, and early motion, more than 100 calcaneal fractures have been treated at the authors' institution between 1985 and 1989. Compared with published reports, the preliminary results demonstrate lower morbidity and improved outcome.