Radiographic and functional outcome of operated closed intra-articular fractures of calcaneum: a retrospective analysis


  • Abhay H. Kerketta Joint Replacement and Orthopaedics, Tata Main Hospital and Manipal Medical College, Jamshedpur, Jharkhand, India
  • Shivanshu Mittal Joint Replacement and Orthopaedics, Tata Main Hospital and Manipal Medical College, Jamshedpur, Jharkhand, India
  • Kumar Rahul Joint Replacement and Orthopaedics, Tata Main Hospital and Manipal Medical College, Jamshedpur, Jharkhand, India
  • Jayanta Kumar Laik Joint Replacement and Orthopaedics, Tata Main Hospital and Manipal Medical College, Jamshedpur, Jharkhand, India



Calcaneum fracture, Intra-articular fracture, Screw vs plate, Communited fracture


Background: The present study aims to analyse the results of surgical outcome of the operated calcaneal fractures using either plates or cannulated cancellous screws. Recently there has been considerable shift of treatment of calcaneal fractures from conservative to operative owing to better understanding of fracture pattern. However, reduction of long-term functional outcome of such patients is always questionable and remains unanswered.

Methods: A 25 fractures were operated with locking plates or cannulated screws after proper assessment. Functional assessment was done using AOFAS scoring system. Radiological outcome was assessed using restoration of Bohler and Gissane angle.

Results: The results were extrapolated as excellent in 20 patients, good in 3 patient's and poor result in 2 patients. Statistical analysis revealed better outcomes in percutaneous cannulated screw fixation as compared to open plate fixation.  6 patients had to undergo implant exit of which 5 were cannulated screw backout, prominence irritating the soft tissue and 1 plate removal had to be done because of infection. None of the patients had subtalar arthritis, heel pad problems, peroneal tendinitis or implant failure.

Conclusions: Surgical management in the treatment of choice for intra articular calcaneal fractures after thorough evaluation. The choice of implant depends upon the communition of fracture, soft tissue compromise, joint surface incongruity and surgical expertise. Radiological maintenance of Bohler and Gissane angle intraoperatively and at follow up is a good indicator for predicting functional outcomes score.  



Seyren M, Çakar M. Results of open reduction and internal fixation in calcaneum. Eur Arch Med Res. 2020;36(2):115-9.

Volpin G, Cohen Z, Kirshner G, Shtarker H. Displaced intraarticular calcaneal fractures current concepts and modern management. J Foot Ankle Surg (Asia Pacific). 2014;1(1):24-31.

Stulik J, Stehlik J, Rysavy M, A Wozniak. Minimally invasive treatment of intraarticular fractures of calcaneum. J Bone Joint Surg. 2006;88(12):1634-41.

Dwivedi R, Khatri M, Arjun K. Functional outcome estimation of calcaneal fractures treated by open reduction and internal fixation with plate and screws in a tertiary centre. A descriptive cross-sectional study. J Nepal Med Assoc. 2020;58(229):659-63.

Bruce J, Sutherland J. Surgical versus conservative intervention for displaced intraarticular calcaneal fracture (Review). Cochrane Database Systematic Reviews. 2013;1:CD008628

Siebe De Boer A, Van Lieshout EMM, Hartog DD, Weerts B, Verhofstad MHJ, Schepers T. Functional outcome and patient satisfaction after displaced intraarticular calcaneal fractures: A comparison among open, percutaneous and non-operative treatment. J Foot Ankle Surg. 2015;54(3):298-305.

Veltman ES, Doornberg JN, Stufkens SAS, Luitse JSK, Van den Bekerom MPJ. Long term outcomes of 1730 calcaneum fracture: A systematic review of the literature. J Foot Ankle Surg. 2013;52:486-90.

Wei N. Operative versus non operative treatment of displaced intra-articular calcaneal fracture. Medicine. 2017;96:49.

Poeze M, Verbruggen JPAM, Brink PRG. The relationship between the outcome of operatively treated calcaneal fractures and institutional fracture load. J Bone Jt Surgery-Am. 2008;90(5):1013.

Makki D, Alnajjar HM, Walkay S, Ramkumar U, Watson AJ, Allen PW. Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases. J Bone Joint Surg Br. 2010;92(5):693-700.

Schindler C, Schirm A, Zdravkovic V, Potocnik P, Jost B, Toepfer A. Outcomes of intra-articular calcaneal fractures: surgical treatment of 114 consecutive cases at a maximum care trauma center. BMC Musculoskelet Disord. 2021;22(1):234.

Agren PH, Wretenberg P, Sayed-Noor AS. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2013;95(15):1351-7.

Phisitkul P, Sullivan J, Goetz J, Marsh J. Maximizingsafety in screw placement for posterior facet fixation in calcaneus fractures: A cadaveric radio anatomical study. Foot Ankle Int. 2013;34(9):1279-85.

Carr J, Tigges R, Wayne J, Mark E. Internal fixation of experimental intraarticular calcaneal fractures: A biomechanical analysis of two fixation methods. J Orthop Trauma. 1997;11(6):425-8.

Smerek JP, Kadakia A, Belkoff SM, Knight TA, Myerson MS, Jeng CL, Percutaneous screw configuration versus perimeter plating of calcaneus fractures: a cadaver study. Foot Ankle Int. 2008;29:931e935.

Fan B, Zhou X, Wei Z, Ren Y, Lin W, Hao Y et al. Cannulated screw fixation and plate fixation for displaced intra-articular calcaneus fracture: A meta-analysis of randomized controlled trials. Int J Surg. 2016;34:64-72.

Walter B, Calcaneal plating with small diameter screws: Mechanical performance and anatomical considerations. Jnj Med Tech. 2015;1-6.

Wang ZJ, Huang XL, Chu YC, Zou YW. Applied anatomy of the calcaneocuboid articular surface for internal fixation of calcaneal fractures. Injury. 2013;44(11):1428-30.

Stoffel K, Booth G, Rohrl SM, Kuster M. A comparison of conventional versus locking plates in intraarticular calcaneus fractures: a biomechanical study in human cadavers. Clin Biomech (Bristol, Avon). 2007;22(1):100-5.

Rak V, Ira D, Masek M. Plates and its complications. Indian J Orthop. 2009;43(3):271-80.






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