الفهرس 
Introduction and aim of the workOnly 14 pages are availabe for public view
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Abstract
study was carried out from December 2008 to November 2010. And dealt with 30 feet with displaced intra- articular calcaneal fractures fixed with anatomical calcaneal plate.
When the cases were presented to our emergency department clinical examination of the affected and contra lateral limb was done. Also urgent vascular examination by doppler or douplex if available. Examination of the spine to exclude any associated spine injuries.
Classification of the cases was based on the Sanders Classification System, 18 (60%) of the 30 feet that had a type-II fracture and 12 case (40 %) were type III fractures .
We used the standard extended lateral technique. The follow up period ranged between 10 and 14 months with an average of 12 months. The patients were followed up till they achieve complete fracture healing and almost normal function.
We used The Maryland Foot Scoring System .A clinician-based outcomes measure. There are five domains: pain (45 points), function with respect to gait (22 points), function with respect to activities (18 points), cosmesis (10 points), and movement of the ankle (5 points). Scores are from 0–100, with 90–100 considered excellent, 75–89 good, 50–74 fair and 0–49 is considered a failure.
The clinical outcome for 10 (33%) of the 30 feet was excellent and 15 (50%) was good . 3 feet (10%) had a fair result, and 2 were considered to have had poor ; of these one feet, needed a subtalar arthrodesis.
And concerning the radiological results . Of the 18 (60%) feet that had type-II fracture 16 of them (88%) had anatomical reduction and 2 cases (12%) had a nearly anatomical reduction . Of the 12 (40%) feet that had a type-III fracture, 8 (66 %) had an anatomical reduction of the posterior facet, 2 had a nearly anatomical reduction, and 2 had malreduction.
And thus we can coclude . In the last decade, open reduction and internal plate fixation of dislocated intra-articular calcaneal fractures has become a standard surgical method with low complication rate and better quality of life after the surgery. The osteosynthesis is more stable, enables earlier weight-bearing.
Distinct advances have been made in the understanding and treatment of displaced intra-articular calcaneal fractures. Computed tomographic scanning has allowed an understanding of the pathological anatomy of these fractures, and two-dimensional computed tomographic scans in both the coronal and the transverse plane are recommended. Classifications based on computed tomographic scanning are prognostic with respect to outcome, and the classification system of Sanders can be applied.
The focus of current treatment is on operative methods, with the goal of restoring not only articular congruency but also the shape and alignment of the calcaneus. Operative treatment should be delayed until swelling has subsided. A lateral approach with use of an extensile incision appears to be associated with the fewest soft-tissue complications. The operative treatment of choice consists of lag-screw fixation of the joint and plate fixation of the calcaneal body, without the use of bone graft. Intra operative fluoroscopy to obtain Brodén’s 32, lateral, and axial radiographs is strongly recommended to ensure an anatomical reduction.
Assessment and treatment of calcaneal fractures have improved substantially over the last two decades. Open reduction and stable internal fixation, have been established as standard management for displaced fractures with good to excellent results in major of cases in larger clinical series.
Anatomical reduction of subtalar joint congruity and restoration of the overall shape of the calcaneus are important prognostic factors. The quality of joint reduction should be reliably proved intra-operatively either with Brodén views or high-resolution fluoroscopy. Treatment results are adversely affected by open fractures, delayed reduction after more than 14 days and individual risk factors, such as a high body mass index and smoking.
Careful management of the soft tissues is equally important as fracture reduction. The extended lateral approach respects the neurovascular supply to the heel and allows a good exposition of the fractured lateral wall, the subtalar and calcaneocuboid joints in complex fractures. In selected, simple fracture patterns percutaneous screw fixation, supplemented by arthroscopic control if necessary, is a good alternative with minimal affection of the soft tissues. Open fractures, compartment syndrome and fractures with severe soft tissue compromise are emergencies.