الفهرس 
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Abstract
The calcaneus is the largest tarsal bone; it plays an important role in carrying the body weight and human locomotion. Numerous controversies have surrounded the management of patients who have a calcaneal fracture; the primary source of disagreement has been the issue of whether better results are achieved with operative or non-operative treatment.
Axial loading is responsible for the majority of intra-articular calcaneal fractures. Usually, the axial load results from a fall from a height. Any fall, even, a short one, may result in fracture as the talus is driven downward into the calcaneus. Twisting forces and avulsive forces cause many of the extra-articular fractures.
Inspite of many attempt to classify fractures of the calcaneus, no simple classification system has been completely satisfactory. Because of the implication of a statement by Cotton and Wilson, 1908, that, it was not possible to classify ”the fracture in a nut subjected to stresses of a nut cracker.” (Delee, 1986).
The aim of our work is to study the outcome of surgical treatment of displaced intra-articular fractures of the calcaneus.
Sixty four patients with seventy two displaced intra-articular fractures of calcaneus were treated by ORIF through the period from February 2008 to December 2014. Males were more affected than females with the ratio of 4.7: 1. The age of the patients ranged from 16 to 60 years with mean age 35.66 years. Blue collar were more affected 82.8%. Falling from a height was the most common cause of injury 78.1%. Bilateral fractures were 12.5% of fractures, right sided fractures were 50% and, left sided fractures were 37.5%. Intra-articular fractures in this series were classified according to Essex-Lopresti into: central depression type in 81.9%and, tongue type in 18.1%. 37.5% of cases were associated with other orthopaedic injuries. Cases were operated between the 1st. day and, 19th. Days after injury, with most of cases were operated within 1st. week 57.8%. Cases were placed on lateral decubitus position or, prone position in bilateral cases and, all operated through extensile lateral approach, which gave us good exposure and is associated with decreased incidence of soft tissues complications. Bone graft was not used in any case of our series. In 60(83.3%) fractures we used inter-fragmentary screws. We used numerous types of plates as; 3.5 reconstruction plates in 33(45.8%) fractures, 3.5 1/3 tubular plates in 6(8.3%), 3.5 L.C.-D.C.P. in 1(1.4%) fracture, Y-shaped plates in 7(9.7%) fractures, Calcaneal plates in 25(34.8%) fractures. Adequate restoration of the Bohler angle is mandatory to achieve good result. A deep haemovac drain is placed in all cases. In the first 18 cases we closed the wound using stapler, we notice high rate of wound dehiscence. After that we started to use the modified Allgöwer-Donati technique to decrease tension on skin edges and then decrease wound edges complication. Early rehabilitation is essential to preserve the motion around the ankle and the subtalar joints. The minimum follow up period was 4 months, while the maximum was45 months, with mean follow up period 11.9 months in this study. Our results, according to Maryland Foot Score were, Excellent in 55 (76.4%) fractures, Good in 15 (20.8%) fractures, Fair in 1 (1.4%) fracture and, Poor in 1 (1.4%) fracture.
Conclusion:
We concluded that intra-articular fractures of the calcaneus should be treated like other intra-articular fractures, i.e., anatomical reduction, stable fixation and, early mobilization. These goals are achievable and give very good to excellent results.