文摘
The treatment of displaced fractures of the talus and calcaneus is associated with a considerable learning curve. Malunion results in significant limitations of global foot function and painful posttraumatic arthritis. While early reduction of dislocations and fracture dislocations represent an emergency situation, the timing of definitive fixation has no measurable impact on the results and the incidence of avascular necrosis in central fractures of the talus. For internal fixation of displaced fractures with central comminution or medial joint impaction, anatomically shaped interlocking plates are available in addition to screws. The ideal treatment of displaced intra-articular calcaneal fractures is still controversial. Because of the variable fracture patterns and the vulnerable soft tissue cover, an individual treatment concept is advisable. In order to minimize the wound margin necrosis associated with extensile lateral approaches, selected fractures should be treated with less invasive fixation while controlling joint reduction via a sinus tarsi approach. Fixation in these cases is achieved with screws, intramedullary locking nails or modified plates that are inserted subcutaneously. Displaced extra-articular and simple intra-articular fractures can be reduced and fixed percutaneously. Functional aftertreatment aims at early rehabilitation independent of the kind of fixation. Peripheral fractures of the talus and calcaneus frequently result from subluxation and dislocation at the subtalar and Chopart's joints. They are still regularly overlooked and result in painful arthritis if left untreated. If an exact anatomical reduction of these intra-articular fractures is impossible, resection of small fragments is indicated.