الفهرس 
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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
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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.
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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.