Operative und konservative Behandlung der Kalkaneusfrakturen

Abstract

Although calcaneal fractures account for only 2% of all fractures, their medical and economical importance is high. Up-to-date treatment of such fractures requires therapy schedules tailored to the soft tissue damage, fracture type and pre-existing diseases and to patient-specific risk factors. From January 1997 to December 1998, 81 patients with closed calcaneal fractures received conservative treatments, and from May 1998 to May 2000 77 patients also with such fractures underwent surgical treatment. While the fractures were comparable in severity in the two groups, there were significantly more very good and good results in terms of Zwipp scores of around 200 points in the operative treatment group, and these were also reflected in the X-ray assessments. In the conservative treatment group earning capacity was reduced by an average of 23.7%, as against 17.8% in the surgical treatment group. In our opinion, conservative treatment is indicated for closed calcaneus fractures when they are not dislocated or only slightly dislocated, when severe soft tissue damage is present, and when the patients have obvious circulatory disorders or severe concomitant diseases. When surgical treatment is indicated we recommend open anatomical reduction and anatomical retention using plate fixation by way of an extended lateral access. © Springer Medizin Verlag 2004.