761 - Calcaneal articular fractures: functional versus surgical treatment. About a series of 80 cases

Objectives: Articular fractures of the calcaneus present a real therapeutic challenge with considerable functional and economic impact. The treatment continues to be at the heart of the controversy between conservative treatment and osteosynthesis.

Design: This is a retrospective comparative study over a period of 11 years, including 43 cases of articular calcaneal fractures treated functionally, and 37 cases treated surgically. Functional (return to work, time to weight-bearing, KITAOKA score) and radiological (time to consolidation, Bohler angle at last follow-up, Kellgren Lawrence subtalar osteoarthritis score, assessment of the hind foot axis) results were collected at last follow-up.

Results: The mean age was 36.5 years. Most fractures were classified as DUPARC V (41.3%). The mean initial Bohler angle was 14.3° in the functional treatment group versus 11.4° in the surgical treatment group. Vertical sinking was the most frequent (52.5%). The KITAOKA score was comparable between the two groups, and the time to weight-bearing and return to work was shorter in the surgical group. Consolidation was achieved in all cases within an average of 12 weeks with no significant difference between the two groups. The mean Bohler angle at the last follow-up was 10.7° in the functional group versus 21.7° in the surgical group. Subtalar osteoarthritis as assessed by Kellgren Lawrence was more prevalent in functionally treated patients than in surgically treated patients.

Conclusions: According to our study, we recommend surgical treatment whenever there is a zero or negative Bohler angle, varus of the greater tuberosity, mixed depression or external bone impingement.