الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Sanders type IV calcaneal fractures are difficult to manage and ends with poor functional outcomes. They are often associated with increased complications rate and secondary subtalar arthritis and subtalar fusion.
There is no consensus about how to manage calcaneal fractures but we can categorize the treatment into four main options: non-operative, open reduction and internal fixation, minimally invasive reduction and fixation and finally Primary ORIF and subtalar arthrodesis.
We conducted this study in Ain Shams university orthopedic department to compare outcomes of Sanders type IV calcaneal fractures treated with open reduction and internal fixation plus primary subtalar arthrodesis versus conservative management then calcaneoplasty and late subtalar arthrodesis after at least three months.
from 2019 till 2022, 34 patients were recruited. Seventeen patients were managed by open reduction and internal fixation plus primary subtalar arthrodesis. the average time interval between trauma and surgery was 18 (range, 9-25) days. Seventeen patients received conservative management for at least three months then calcaneoplasty and late subtalar arthrodesis. The average time interval between trauma and surgery was 9 (range, 5-12) months. The minimum follow-up duration was 2 years.
The data of twenty-nine patients were collected for analysis, while 5 patients were lost during follow-up. We assessed regarding functional outcomes in the form of AOFAS-AHS and FAAM scores, wound complications and the need for second surgeries.
Both groups showed low functional scores and that reflected the severity of injury. Primary subtalar arthrodesis showed higher scores but with no statistical difference.
Wound complications were comparable between both groups. Two patients in group A had second surgery for heel valgus correction and prominent implants.
CONCLUSION
In conclusion, primary subtalar fusion is a successful treatment option for these severe life changing fractures. It may offer better functional outcomes than late subtalar fusion in the short term (one year) besides decreasing the disability time.
More research is needed to establish the best treatment for these challenging debilitating fractures.