Journal of Musculoskeletal Trauma

Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients: Comparison of the Minimally Invasive Approach and Extensile Lateral Approach: Hong Ki Park, Jae Yoon Ko, Seung Kwan Lee, Jong Min Baik; J Korean Fract Soc 2019;32(3):135-142. Published online July 31, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.3.135

PURPOSE
As the functional demands for activities in elderly patients are increasing according to their life extension, the need for surgical treatment is also increasing in elderly patients with displaced intra-articular calcaneal fractures. In addition to the extensile lateral approach (ELA), which is a surgical procedure that showed good results on intra-articular calcaneal fractures, the minimally invasive approach (MIA) also showed an outstanding result. This study compared the radiological and clinical results of intraarticular calcaneus fractures in elderly patients in two groups: ELA and MIA.
MATERIALS AND METHODS
Thirty patients aged over 65 years with intra-articular calcaneus fractures, who could be followed-up more than 14 months, were included in this study. Thirteen patients of the MIA group and 17 patients of the ELA group were analyzed retrospectively using radiological and clinical assessments.
RESULTS
No significant difference in union time, posterior facet reduction accuracy, subtalar osteoarthritis frequency, Bohler angle, calcaneal width, American Orthopaedic Foot and Ankle Society score, visual analogue scale score, 36-item short form survey, and foot function index was observed between the two groups. The p-value of the average height of the calcaneus correction, average length of calcaneal correction, and average loss of correction length were <0.001, 0.005, and 0.015, respectively. The incidence of complications, including soft tissue necrosis and bone infection, were 23.1% in the ELA group and none in the MIA group.
CONCLUSION
The clinical outcomes were similar in the two groups. The degree of reduction of fracture showed a better result in the MIA group than the ELA group. Furthermore, there were no complications in the MIA group, whereas the ELA group showed some complications.

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Clinical and Radiological Outcomes of ‘Blocking Kirschner Wire Technique’ in Displaced Intra-Articular Calcaneal Fractures via the Extended Sinus Tarsi Approach
Jeong-Kil Lee, Chan Kang, Sang-Bum Kim, Gi-Soo Lee, Jung-Mo Hwang, Byung-Kuk An
Journal of the Korean Orthopaedic Association.2021; 56(3): 224. CrossRef

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Treatment of Intra-articular Calcaneal Fractures Using Minimally Invasive Sinus Tarsi Approach in Diabetic Patients: Hong Moon Sohn, Sang Ho Ha, Sang Hong Lee, Jun Young Lee, Jeong Ho Kim, Sang Jun Lee; J Korean Fract Soc 2008;21(3):195-199. Published online July 31, 2008; DOI: https://doi.org/10.12671/jkfs.2008.21.3.195

Abstract PDF: PURPOSE
Wound problems occur in 5~30% of intra-articular calcaneal fractures following operation. Diabetes mellitus, large incisions and abundant dissection can increase the risk of wound problems that may require skin graft or other additional care. The authors used minimally invasive technique to treat intra-articular calcaneal fractures in diabetic patients and evaluated the results and complications of this method. MATERIALS AND METHODS: Between January 2002 and July 2005, 12 patients with intra-articular calcaneal fractures who had underlying diabetes mellitus were treated using minimally invasive technique with a modified sinus tarsi approach. The patients had an average age of 47 years (39~67) and were followed an average of 19 months (13~32). The mean period between injury and operation was 8 days (5~14). Crutch assisted partial weight bearing was advised for an average of 7.3 weeks (6~9) and full weight bearing was allowed after average of 9.3 weeks (7~11).
RESULTS
According to AOFAS scale for ankle and hindfoot, patients had the following results: excellent - 1 patient (8%), good - 9 patients (75%), fair - 1 patient (8%), unsatisfied - 1 patient (8%). Bone union was achieved in all cases and there were no events of deep infection or skin necrosis.
CONCLUSION
Treating intra-articular calcaneal fractures by minimally invasive technique is an excellent operative method for patients with diabetes mellitus, as this method can minimize soft tissue incision and resulting deep infection and skin necrosis.

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Joint Depression Type of Intraarticular Calcaneal Fractures Treated with Essex-Lopresti Method: Gyu Min Kong, Byoung Ho Suh, Dong Joon Kim; J Korean Fract Soc 2007;20(2):178-183. Published online April 30, 2007; DOI: https://doi.org/10.12671/jkfs.2007.20.2.178

Abstract PDF

PURPOSE
To evaluate the result of joint depression type of intraarticular calcaneal fractures treated with Essex-Lopresti method.
MATERIALS AND METHODS
From March 2001 to February 2005, Thirty two patients' joint depression type of intraarticular calcaneal fractures which treated with Essex-Lopresti method were clinically and radiographically evaluated retrospectively.
RESULTS
According to Creighton-Nebraska Health Foundation Assessment Score (C-N score), there were 5 excellent, 11 good, 6 fair and 10 poor results. BÃ¶hler angle was corrected from 10.3 degrees to 24.5 degrees. There was a positive correlation between size of depressed fragment and C-N score (p<0.01).
CONCLUSION
Essex-Lopresti method can substitute open reduction methods in joint depression type of intraarticular calcaneal fractures which have relatively large depressed joint fragments.

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Treatment of Calcaneus Fractures: Recent Trend for Acute Fractures and Complications
Woo-Chun Lee
Journal of the Korean Fracture Society.2007; 20(4): 361. CrossRef

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Operative Treatment of Intraarticular Calcaneal Fracture: Comparison of Outcomes between Open Reduction and Closed Reduction: Chang Hun Sung, Byeong Mun Park, Kyeong Seop Song, Hyung Gyu Kim, Jong Min Kim, Tae Eun Kim; J Korean Fract Soc 2005;18(2):170-175. Published online April 30, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.2.170

Abstract PDF

PURPOSE
To evaluate the clinical outcomes and radiographic results of operative treatment for intraarticular calcaneal fracture.
MATERIALS AND METHODS
We reviewed 57 cases of intraarticular calcaneal fracture managed with operative treatment, from January, 2000 to June, 2003. The type of intraarticular calcaneal fracture is classified by the Essex-Lopresti classification and Sanders by computed tomography. The 20 cases were managed by open reduction, 37 cases by closed reduction.
RESULTS
On clinical outcomes in the case of open reduction and internal fixation, above good in 13 cases, poor in 2 cases; closed reduction, above good in 16 cases, poor in 10 cases. Averages of Bohler angle were increased from 11degrees (preoperative state) to 21degrees (last follow up) in open reduction, and from 14degrees to 20.9degrees in closed reduction.
CONCLUSION
Open reduction was considered to be one of good treatment option if the anatomical reduction and stable fixation can be obtained.

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Comparative Study of Open Reduction and Internal Fixation and Primary Subtalar Arthrodesis for Sanders Type 4 Intra-Articular Calcaneal Fractures
Seung Hun Woo, Hyung-Jin Chung, Su-Young Bae, Sun-Kyu Kim
Journal of the Korean Orthopaedic Association.2017; 52(1): 49. CrossRef
Joint Depression Type of Intraarticular Calcaneal Fractures Treated with Essex-Lopresti Method
Gyu Min Kong, Byoung Ho Suh, Dong Joon Kim
Journal of the Korean Fracture Society.2007; 20(2): 178. CrossRef
Treatment of Calcaneus Fractures: Recent Trend for Acute Fractures and Complications
Woo-Chun Lee
Journal of the Korean Fracture Society.2007; 20(4): 361. CrossRef

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Early Postoperative Complications of Calcaneal Fractures Following Operative Treatment by a Lateral Extensile Approach: Young Soo Byun, Young Ho Cho, Jun Woo Park, Jin Seok Lee, Ji Hwan Kim; J Korean Fract Soc 2004;17(4):323-327. Published online October 31, 2004; DOI: https://doi.org/10.12671/jkfs.2004.17.4.323

Abstract PDF

PURPOSE
To analyze early postoperative complications of calcaneal fractures operated by a lateral extensile approach and to identify risk factors for wound complications.
MATERIALS AND METHODS
From July 1990 to February 2003, 116 calcaneal fractures in 104 patients were treated by open reduction and internal fixation through a lateral extensile approach. The patient's records were reviewed for early postoperative complications. Statistical analysis was performed to determine significant relationships between predicted variables and the development of wound complications.
RESULTS
Fourteen fractures (12.0%) developed infection. Ten of them were superficial infection and four were deep infection that required surgical treatment. Eight fractures (6.9%) developed skin necrosis. Six of them were marginal skin necrosis and two were flap necrosis that required surgical treatment. Seven fractures (6.0%) developed sural nerve injury, but their symptoms were improved without additional treatment. Open fracture (p=0.003) and prolonged operating time (p=0.049) increased significantly the rate of wound complications.
CONCLUSION
The rate of early postoperative complications of calcaneal fractures operated by a lateral extensile approach is high. These complications can be reduced by meticulous treatment of an open wound, reduced operating time within 90 minutes through preoperative planning and skillful technique, and correct incision to avoid damage of the sural nerve.

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Results in Operative Treatment of Open Calcaneal Fracture
Ba Rom Kim, Jun Young Lee, Donghyuk Cha
Journal of Korean Foot and Ankle Society.2021; 25(3): 133. CrossRef
Bilateral Open Transcalcaneal Fracture with Talonavicular Dislocation - A Case Report -
Hun Park, Sung Jin Shin, Sang Rim Kim, Kwang Woo Nam, Sung Wook Choi, Kyu Bum Seo, Jun Young Seo
Journal of the Korean Fracture Society.2011; 24(1): 87. CrossRef
Treatment of Intra-articular Calcaneal Fractures Using Minimally Invasive Sinus Tarsi Approach in Diabetic Patients
Hong-Moon Sohn, Sang-Ho Ha, Sang-Hong Lee, Jun-Young Lee, Jeong-Ho Kim, Sang-Jun Lee
Journal of the Korean Fracture Society.2008; 21(3): 195. CrossRef

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Usefulness of CT Scan in Treatment of Calcaneal Fracture: Hak Jun Kim, Kwon Ick Ha, Jeong Ro Yoon, Jae Ik Shim, Taik Seon Kim, Young Bae Kim, Woo Seung Lee, Jae Hyuck Choi; J Korean Soc Fract 2003;16(4):526-533. Published online October 31, 2003; DOI: https://doi.org/10.12671/jksf.2003.16.4.526

Abstract PDF

PURPOSE
Accurate fracture classification is difficult because of its complex bony architecture and there is no definitive treatment modality according to fracture pattern or classification. We evaluated the fracture pattern using simple radiography and CT scan simultaneously and then the result according to treatment modalities and fracture classification.
MATERIALS AND METHODS
We evaluated 24 patients (26 cases) who suffered intraarticular calcaneal fracture were treated with closed reduction and axial pinning or open reduction and plate fixation. There were had taken CT scan. Fractures were classified with two different manner using both plain radiography and CT scan. Essex-Lopresti classification was made with plain radiography and Sanders classification was made with CT scan. Radiographic results were measured of preoperative and postoperative Bohler angle on plain x-ray. 16 patients (17 cases) were analyzed for clinical outcomes by Salama's criteria focused on pain, patients' satisfaction, walking abilities and usage of orthosis.
RESULTS
Mean followed-up period was 6 years (range 1~8.8 years). 8 cases were classified into tongue type intraarticular calcaneal fractures by plain radiography and 9 cases into joint depression type. According to Sanders classification by CT scan, 5 cases were classified into type IIA, 1 case IIC, 4 cases type IIIA, 4 cases IIIB and 3 case type IV. 12 fractures were reduced by closed reduction and axial fixation and 5 cases by open reduction and internal fixation. There was no correlation between clinical outcomes and treatment modality but there was linear correlation between clinical outcomes and postoperative Bohler angle (correlation coefficient = 0.04). In 8 cases of tongue type by plain radiography, sanders type IIC was only 1 case which calcaneal tuberosity connected to articular facet but articular involvements were observed in remaining cases.
CONCLUSION
Accurate eavaluation of articular facet in calcaneal fracture by CT scan is necessary to determining to select the treatment option.

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Physiological Characteristics and Anti-Obesity Effect of Lactobacillus plantarum K6 isolated from Kimchi
Seulki Kim, Sang-Dong Lim
Journal of Milk Science and Biotechnology.2017; 35(4): 221. CrossRef

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The Radiologic Evaluation of Treatment Outcome in Intra-articular Calcaneal Fracture by Open Reduction without Bone Graft: Kwang Soon Song, Si Hyun Jeon, Jae Hong Chun; J Korean Soc Fract 2002;15(2):226-233. Published online April 30, 2002; DOI: https://doi.org/10.12671/jksf.2002.15.2.226

Abstract PDF

PURPOSE
The purpose of this study was to investigate the efficacy of bone graft use in the treatment of displaced intra-articular calcaneal fractures.
MATERIALS AND METHODS
We analysed retrospectively 40 displaced intra-articular calcaneal fractures, which had undergone open reduction and internal fixation without bone graft from June 1989 to July 1998. Radiological assessments were made from the lateral view of the affected calcaneus, recording the Bohler angle, the Gissane angle and ratio of height/width of the calcaneus. Matching criteria included Essex-Lopresti classification, method of fixation, age, and sex.
RESULT
The mean preoperative Bohler angle was -7 degrees(standard deviation [S D ] 1 8 degrees), postoperative Bohler angle was 21 degrees(SD 7 degrees), last follow-up Bohler angle was 1 9 degrees(SD 7 degrees). Bohler angle increased a mean 28 degrees(maximum 70 degrees, minimum 2 degrees). The preoperative Gissane angle was 104 degrees(SD 17.87 degrees), postoperative Gissane angle was 1 0 6 . 2 degrees(SD 10.07 degrees), last follow-up Gissane angle was 104.48 degrees(SD 10.1 degrees). The preoperative ratio of height/width of the calcaneus was 0.568(SD 0.076), postoperative ratio was 0.637(SD 0.037), last follow-up ratio was 0.648(SD 0.038). There was no significant differences in fracture pattern, method of fixation, age, and sex(P>0.05).
CONCLUSION
The result of this study showed that there was no significant change in serial radiologic evaluation. Bone graft was not served to the effectiveness or security in the treatment of displaced intra-articular calcaneal fractures.

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Open Reduction and Internal Fixation with AO Calcaneal Plate for Displaced Intra-articular Calcaneal Fracture
Myung Jin Lee, Sung Keun Sohn, Kyu Yeol Lee, Sung Soo Kim, Min Soo Kang, Hyeon Jun Kim, Sang Kyu Sun
Journal of the Korean Fracture Society.2010; 23(3): 303. CrossRef

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Correlation of the Clinical Outcome and Radiographic Measurement of the Calcaneal Fractures: Dong Eun Shin, Jin Yong Kim, Dong Bae Shin, Yong Jung Kim, Soo Hong Han, Young Je Soung; J Korean Soc Fract 2001;14(4):698-705. Published online October 31, 2001; DOI: https://doi.org/10.12671/jksf.2001.14.4.698

Abstract PDF

PURPOSE
To evaluate the prognostic factors associated with the clinical outcome, which analysed with use of the Pearson correlation method in AOFAS score and radiographic measurement between normal and the affected site after operative treatment of the calcaneal fractures.
MATERIALS AND METHODS
We evaluated 13 patients(13 cases) who had unilateral calcaneal fractures. At the latest follow-up, we calculated the mean differences of the Bohler angle, gissane angle, heel height, calcaneal width, calcaneal length, talocalcaneal angle, talar declination angle, subtalar incongruity between normal and affected site on the lateral view of ankle and tangential view of the calcaneus. And then the correlation between radiographic measurement and the clinical outcome analysed by Pearson correlation method.
RESULTS
Heel height(correlation coefficient = 0.827, p-value<005) and subtalar incongruity(correlation coeffidient = -0.764, p-value<0.05) were closely correlated with the clinical outcome and the B hler angle showed lower correlation coefficiency(correlation coefficiency = 0.470, p-value : 0.104) compare to the heel height.
CONCLUSION
We suggested that restoration of the heel height and subtalar incongruity was significantly correlated to the clinical outcome after operative treatment of the calcaneal fractures.

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The Comparison of Radiographic Parameters and Clinical Results after Operative Treatment of Displaced Intraarticular Calcaneal Fractures
Hong Moon Sohn, Jun Young Lee, Sang Ho Ha, Sueng Hwan Jo
Journal of the Korean Fracture Society.2007; 20(3): 227. CrossRef

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Result of Surgical Treatment of Calcaneal Fractures Using Extensile Lateral Approach: Sung Do Cho, Yong Sun Cho, Bum Soo Kim, Tae Woo Park, Gi Bong Kim, Key Yong Kim; J Korean Soc Fract 1999;12(2):320-327. Published online April 30, 1999; DOI: https://doi.org/10.12671/jksf.1999.12.2.320

Abstract PDF

Thirty-eight calcaneal fractures were treated with open reduction and internal fixation using extensile lateral approach from Jun. 1993 to Dec. 1996 and were followed more than a year. According to the Essex-Lopresti classification, there were 28 cases of joint depression type and 10 cases of tongue type. According to the Sanders classification, there were 20 cases of type II, 13 cases of type III and 5 cases of type IV. The purpose of this study is to analyze the results of surgical treatment of calcaneal fractures using extensile lateral approach and its complications. The results were as follows; 1. B.. ohler angle was improved from -2.4degrees to 20.5degrees and Gissane angle was improved from 114.5degrees to 120.4degreesafter the operation. The height of the calcaneus was improved from 75% to 95% and the width of the calcaneus was reduced from 119% to 106% of contralateral side. 2. yThe postoperative reduction status of the articular surface was analyzed by computed tomography(CT) in 18 patients and was found to be less than 2 mm of step-off in 10 cases, between 2 and 5 mm in 7 cases and more than 5 mm in 1 case. 3. Based on the assessment criteria of Salama et al., the functional results were excellent in 10 cases, good in 14 cases, fair in 10 cases, and poor in 4 cases. Unsatisfactory results were correlated with severity of articular comminution and failure to obtain accurate reduction of the articular surface. 4. Fourteen cases (36.8%), developed postoperative complications such as heel pain, causalgia and numbness, subtalar arthritis, marginal necrosis of wound, lateral subfibular impingement and heel bulging. In conclusion, Because of high incidence of postoperative complications, careful and meticulous exposure technique in doing extensile lateral approach are necessary for a satisfactory outcomes.

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Treatment of Intra-articular Calcaneal Fractures Using Minimally Invasive Sinus Tarsi Approach in Diabetic Patients
Hong-Moon Sohn, Sang-Ho Ha, Sang-Hong Lee, Jun-Young Lee, Jeong-Ho Kim, Sang-Jun Lee
Journal of the Korean Fracture Society.2008; 21(3): 195. CrossRef

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A critical Analysis of Long-Term Result and Prognostic Factors of Fractures of the Calcaneus: Ig Gon Kim, Jae Hyek Kim, Chul Hyun Kim, Jong Suck Kim; J Korean Soc Fract 1998;11(2):354-361. Published online April 30, 1998; DOI: https://doi.org/10.12671/jksf.1998.11.2.354

Abstract

Forty-six patients who had had forty-nine calcaneal fractures were managed with closed reduction and a cast, closed reduction and axial pin fixation, and open reduction and internal fixation. The results were reviewed retrospectively, between twelve months and twenty-six months after the treatment, with criteria usued in assesssment of result by Salama30) and with plain radiographs. The purpose of this study were to analyze the relationship between the prognostic factors and post-treatment results. The results of treatment and prognostic factors obtained from this study were as follows. 1. The negative prognostic factors that were associated with an unsatisfactory out come were an age of more than fifty years, a greater body weight, work involving strenuous labor, subtalar incongruity, a decreased fibulocalcaneal space, and a decreased B hler-angle ratio of the fractured to the normal side. 2. Patients who had had a tongue-type fracture had a better result than those who had had a central depression fracture, while those who had had a central depression fracture had a better outcome than those who had had a comminuted fracture. 3. The length of the Achilles-tendon fulcrum, which is directly related to the calcaneal length, was not related to the outcome.

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Open Reduction and Internal Fixation with AO Calcaneal Plate for Displaced Intra-articular Calcaneal Fracture
Myung Jin Lee, Sung Keun Sohn, Kyu Yeol Lee, Sung Soo Kim, Min Soo Kang, Hyeon Jun Kim, Sang Kyu Sun
Journal of the Korean Fracture Society.2010; 23(3): 303. CrossRef

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The Classiflcation and Management of Intraarticular Calcaneal Fracture Based on Computed Tomography: Jae lk Shim, Taik Seon Kim, Sung Jong Lee, Suck Ha Lee, Chang Moo You, Young Bae Kim; J Korean Soc Fract 1996;9(3):742-749. Published online July 31, 1996; DOI: https://doi.org/10.12671/jksf.1996.9.3.742

Abstract PDF

Displaced intraarticular fractures of the calaneus require operative intervention to restore the anatomy of the bone, which in turn is the requirement for recovery of subtalar joint mobility. To evaluate the complex contour of calcaneal anatomy, a classification for intraarticular calcaneal fractures was used, based on standardized coronal and transverse computed tomography scans of os calsis. From January 1993 to December 1994, intraarticular calcaneal fractures of 47 cases treated in Korea Veterans Hospital were analysed preoperatively with C.T. scan and classified by Sandersclassification system. And clinical evaluation of the patients was done by Maryland Foot Score postoperatively. The result were as follows:Type I fractures were found in 10 cases. 25 cases of 47 cases were classified as type II and subdivided as II A in 13 cases, II B in 6 cases, II C in 6 cases. Type III fractures were found in 8 cases and subdivied as III AB in 4 cases, III BC in 3 cases, III AC in 1 case. Type IV fractures were found in 4 cases. This classification aids a surgeon to make perioperative decision, because it has prognostic significance.

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Surgical Outcome of Stable Scaphoid Nonunion without Bone Graft
Eun Sun Moon, Myung Sun Kim, Il Kyu Kong, Min Sun Choi
Journal of the Korean Fracture Society.2010; 23(1): 69. CrossRef
The Comparison of Radiographic Parameters and Clinical Results after Operative Treatment of Displaced Intraarticular Calcaneal Fractures
Hong Moon Sohn, Jun Young Lee, Sang Ho Ha, Sueng Hwan Jo
Journal of the Korean Fracture Society.2007; 20(3): 227. CrossRef

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Open Reduction and Interrial Fixation of Displaeed Intraartieular Fractures of Calcaneus: Eun Kyoo Song, Dong Hyun Ryang; J Korean Soc Fract 1992;5(2):205-211. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.205

Abstract PDF: Nine displaced intraarticular fractures of the calcaneus involving subtalar joint in six patien ts were treated by open reduction and internal fixation with plate at department of orthopedic surgery, chonnam university hospital from April 1990 to October 1991. The clinical and radiographic results were analysed after follow-up from five to twenty three months. 1. Of 9 fractures, 7 fractures were joint depression type and 2 fractures were tongue type by Essex-Lopresti classification.2. The operations were performed though lateral approach in 8 cases and medial approach in 1 case. 3. At final follow-up 12 months in average the assessments of results by Salama and Rowe unit system showed satisfactory results in 89% and 67%, respectively. 4. The averge Bohler angle was -6.1 before operation and increased to 16.4 at final follow up. 5. The common complication were pain around ankle and heel, subtalar arthritis and cal-caneal deformlty etc.

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Operative Treatment of Intra-articular Calcaneal Fractures by Posterior Approaeh: Youn Soo Kim, Ckoong Seo Park, In Tak Chu, Hyoung Min Kim, Jae Duk Ryu; J Korean Soc Fract 1992;5(2):191-198. Published online November 30, 1992; DOI: https://doi.org/10.12671/jksf.1992.5.2.191

Abstract PDF: In contrast to the extra-articular calcaneal fractures, the treatment of intra-articular fractures is very difficult and the final result is not always satisfactory, because it has not only difficulties in the identification of the exact fracture pattern and an anatomical reduction of the fracture fragments, but also no principle of ideal treatment. Today, numerous controversies remain regarding the treatment of intra-articular calcaneal fractures, which include the need of reduction, the method of reduction, the surgical approach. the method of fixation, and the need of bone graft. We propose the posterior approach and longitudinal buttress screw fixation for the treatment of intra-articular calcaneal fractures. The posterior approach allows excellent visualization of the posterior facet of subtalar joint, and the longitudinal screw buttresses the posterior facrt fracture fragment of calcaneus. From Dec. 1990 to May 1992, 17 intra-articular calcaneal fractures out of 15 patients were treated by our surgical method and followed up (average, 9.2 months) in 12 cases out of 10 patients (2 bilateral cases). Seven cases were tongue type fractures and five were joint do- pression type. Operations were performed 5 to 15 days after accident(average, 92 days). Bone graft was performed only 3 cases. At last follow-up, there was no pain in 8 cases. intermittant dull pain in 3, and resting pain in 1. The Bohlers angle at post-accident and last follow-up were 5.9 and 30.7 in tongue type : 10.6 and 32.6 in joint depression type. The reduction of the fracturr fragments was maintained well and secondary deformities were not developed in all cases. Based on these findings in this study, most of the intra-articular calcaneal fractures can be reduced anatomically by posterior approach, and fracture fragment maintained by longitudinal buttress screw fixation.

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