The long-term follow-up of intra-articular calcaneal fractures is often accompanied by complications. Frequently occurring are arthrosis, arthrofibrosis of the subtalar joint, and malunion. Uncommon is the calcaneal nonunion. A total of three cases is presented in this report, including a review of the literature. The occurrence of a nonunion appears to be more common after conservative treatment, but the pathophysiology remains unclear, however smoking may play a role

EVA Lim

H Thermann

H Zwipp

J Gehr

JL Howard

JM Hoogendoorn

L Karakurt

M Assous

ME Easley

P Thomas

Peter Patka

R Sanders

T Schepers

Tim Schepers

English

PubMed

Schepers, T. (Tim)

Patka, P. (Peter)

Erasmus University Digital Repository

Arch Orthop Trauma Surg (2008) 128:735–738  DOI 10.1007/s00402-007-0516-3TRAUMA SURGERYCalcaneal nonunion: three cases and a review of the literatureTim Schepers · Peter Patka Received: 25 May 2007 / Published online: 15 December 2007©  The Author(s) 2007Abstract The long-term follow-up of intra-articularcalcaneal fractures is often accompanied by complications.Frequently occurring are arthrosis, arthroWbrosis of thesubtalar joint, and malunion. Uncommon is the calcanealnonunion. A total of three cases is presented in this report,including a review of the literature. The occurrence of anonunion appears to be more common after conservativetreatment, but the pathophysiology remains unclear, how-ever smoking may play a role.Keywords Calcaneus · Fracture · Pseudarthrosis · NonunionIntroductionDuring long-term follow-up after intra-articular calcanealfractures complications frequently occur. In clinicalpractice, arthrosis and arthroWbrosis of the subtalar joint,malunion and nonunion are encountered [8, 12]. Nonunionis only rarely found, and studies concerning complica-tions after intra-articular calcaneal fractures do notdescribe this complication [5, 7]. In only Wve studies,including nine patients, reports on nonunion are made [3, 6,10, 11, 13]. Three patients with a pseudarthrosis after anintra-articular fracture of the calcaneus are presented inthe current study.CasesCase 1A male adult (age 49) fell from a height of 2 m fracturinghis left calcaneus. According to the Essex–Lopresti classiW-cation he sustained a joint-depression type, and a type IIAfracture according to the Sanders classiWcation. There wasno injury to the soft tissues. After 6 days the fracture wasoperated on, using percutaneous reduction and Wxationaccording to the technique of Forgon and Zadravecz [9].Post-operative treatment consisted of active range ofmotion exercises and 3 months non-weight bearing. Initialrecovery was uncomplicated. Two years after the trauma,the patient however returned to our outpatient departmentwith complaints of painful walking, and unable to work. Acomputed tomography (CT) scan showed a pseudarthrosisof the calcaneus and talocalcaneal joint surface incongru-ence (Fig. 1). An injection of 10 cc lidocain in the subtalarjoint temporarily reduced pain. A subtalar joint arthrodesiswas performed, fusing the talus and calcaneus with the useof bone graft gained from the iliac crest. After 1 year thearthrodesis has fully consolidated, the patient is pain free,but has currently not yet returned to work.Case 2A female patient, aged 53, sustained a fracture of the rightcalcaneus after a fall from the stairs (Essex–Lopresti jointdepression type, Sanders type IIB). As patient was seenthree weeks after the trauma, the initial treatment was con-servatively, consisting of 1 week of plaster-of-Paris and3 months non-weight bearing with active range of motionexercises. Two months later the patient was unable to bearweight at the fractured side due to pain. A CT showed aT. Schepers (&) · P. PatkaDepartment of Surgery-Traumatology, Erasmus MC, University Medical Center Rotterdam, Room H 974, Rotterdam  3000 CA, The Netherlandse-mail: t.schepers@erasmusmc.nl123736 Arch Orthop Trauma Surg (2008) 128:735–738delayed union of the calcaneus (Fig. 2). Peroperatively,6 months after trauma, there was a nonunion of the fracture,without apparent signs of arthrosis of the talocalcaneal jointsurface. Because of the smoking habits and diabetes in thispatient, as independent causes of high wound complicationrates, an early subtalar arthrodesis with bone graft har-vested from the tibial tuberosity was performed instead of acorrecting osteotomy. Three months after the salvageoperation the arthrodesis had consolidated, the patient iswalking pain free.Case 3A male adult, of 39-years-old, sustained a bilateral calca-neal fracture after jumping of a Wrst storey balcony. Theradiographs showed a comminuted intra-articular calcanealfracture according to the Essex–Lopresti classiWcation atboth sides and Sanders type IIC and IIIAC fractures on theleft and right foot, respectively. Initial treatment was con-servative, consisting of 1 week of plaster-of-Paris and3 months non-weight bearing with active range of motionexercises. Thirteen months later the patient returned to theoutpatient department with complaints of pain at the leftheel. Additional radiographs and CT showed a nonunion ofthe fracture of the left calcaneus (Fig. 3). A subtalararthrodesis was performed, with bone graft from the tibialtuberosity. Two cannulated screws were inserted from thetuberosity of the calcaneus, bridging the primary fractureline. The after treatment was complicated with a superWcialinfection, which could be treated adequately with intrave-nous antibiotics. Six months after the secondary fusion thepatient was able to walk pain free.DiscussionImproper healing after an intra-articular calcaneal fracturecarries a high morbidity. Three groups: A, malunion; B,nonunion; and C, osteonecrosis, were suggested by Zwipp[13]. These groups are further divided according to thepresence of joint incongruence, varus/valgus, loss of height,translation of bones and luxation. Treatment of theseFig. 1 a Case 1: Axial CT-scan image 22 months after percutaneous reduction and Wxation showing nonunion; b Sagittal viewFig. 2 a Case 2: Semi-coronal CT-scan image 5 months after conservative treatment showing delayed union; b Sagittal view123Arch Orthop Trauma Surg (2008) 128:735–738 737complications after intra-articular calcaneal fracturesdepends upon the presence of these conditions [13].The Wrst written report on calcaneal fracture nonunionwas by Thomas (1993). He presented a 36-year-old femalepatient, treated non-operatively, who developed a calcanealnonunion after 6 months [11]. A correction of the displacedfragment was performed and stabilized using plate osteo-synthesis and bone graft. The patient was able to fully bearweight 12 weeks after this procedure.Gehr described a 38-year-old male patient with an intra-articular, comminuted fracture of the calcaneus [3]. Thisfracture was treated with open reduction and internal plateosteosynthesis. After removal of the plate at 18 months thepatient returned to the clinic with local swelling and painduring walking. A nonunion was seen and a correctionosteotomy was performed with bone graft and screw Wxa-tion. The fracture showed healing at 8 weeks.Karakurt et al. [6] presented one 42-year-old malepatient with a nonunion of the calcaneus after conservativetreatment. The patient sustained a comminuted, open calca-neal fracture which was treated in plastercast for 6 months.Eight months after trauma the patient was unable to walkwithout crutches because of severe pain of the heel. Afterremoving Wbrotic tissue the calcaneus was Wlled with bonegraft. Eight months after the operation patient was able towalk and work without pain.Zwipp and Rammelt [13] reported two patients with anonunion of the calcaneus. A 61-year-old female patient,with a Sanders IIC fracture with a luxation of the tuberosityfragment, was treated conservatively. An arthrodesis of thesubtalar and calcaneocuboid joint was performed 6 monthsafter trauma. Postoperatively the American Orthopaedicfoot and Ankle Society hindfoot score improved signiW-cantly, compared with pre-operative values. The secondpatient was a 45-year-old female polytrauma patient. Afterpercutaneous reduction and Wxation she was diagnosedwith a nonunion 1 year after the trauma, for which a subta-lar joint arthrodesis was performed. No data on outcomewas provided in this case.From cases described in literature and in the currentreport no similarities that could indicate a risk factor ofnonunion could be found. There are no apparent similaritiesbesides the nonunion (Table 1). There might be a trend ofnonunion occurring after conservative treatment, suggestingFig. 3 a Case 3: Semi-coronal CT-scan image 13 months after conservative treatment showing nonunion; b Sagittal viewTable 1 Summary of patients presented in the literature after a calcaneal nonunionStudy Gender Age Initial treatment Salvage procedure Follow-up*(months)Thomas and Wilson [11] Female 36 Conservative Osteotomy, plate, bone graft 3Thermann et al. [10] – – – Subtalar arthrodesis 62Gehr et al. [3] Male 38 ORIF Osteotomy, screws, bone graft 2Karakurt et al. [6] Male 42 Conservative Bone graft 8Zwipp and Rammelt [12] Female 61 Conservative Subtalar arthrodesis, calcaneocuboid joint fusion–Female 45 Percutaneous Subtalar arthrodesis –Current study Male 49 Percutaneous Subtalar arthrodesis 14Female 53 Conservative Subtalar arthrodesis 3Male 39 Conservative Subtalar arthrodesis 6* The follow-up period after the salvage procedure is given123738 Arch Orthop Trauma Surg (2008) 128:735–738that less rigid or no Wxation may play a role in causingfracture nonunion in the calcaneus. However Howard et al.[5] saw no cases of nonunion in a group of 164 intra-articu-lar calcaneal fractures treated nonoperative. Patient age var-ied between 36 and 61, both sexes were aVected equallyoften and initial treatment diVered between patients. Kara-kurt et al. [6] suggested that smoking could be the cause ofthe nonunion. All patients in this report were smokers. Fortibial fractures strong evidence exists for delayed fracturehealing in smokers [4]. And a signiWcant lower union-ratewas seen after subtalar arthrodesis in smokers versus non-smokers [2]. Assous et al. [1] however saw no diVerence infracture healing between smokers and non-smokers in asmall series of intra-articular calcaneal fractures treatedoperatively.In contrast to the infrequent occurrence of the calcanealnonunion, stated in the case reports above, Thermann et al.[10] describe an in incidence of 10% nonunion (n = 4/40) ina group of patients receiving a subtalar arthrodesis for per-sisting invalidating pain after an intra-articular calcanealfracture. In these four patients the nonunion coincided withpainful subtalar posttraumatic arthrosis, delineating theindication for a subtalar arthrodesis, instead of a correctionosteotomy with internal Wxation.Calcaneal nonunion has been reported on infrequently inthe literature, but the number of patients seen by Thermann,and our own series, suggests that the incidence might behigher than expected.Open Access This article is distributed under the terms of theCreative Commons Attribution Noncommercial License whichpermits any noncommercial use, distribution, and reproduction in anymedium, provided the original author(s) and source are credited.References1. Assous M, Bhamra MS (2001) Should Os calcis fractures in smok-ers be Wxed? A review of 40 patients. Injury 32(8):631–6322. Easley ME, Trnka HJ, Schon LC, Myerson MS (2000) Isolatedsubtalar arthrodesis. J Bone Joint Surg Am 82(5):613–6243. Gehr J, Schmidt A, Friedl W (2000) Calcaneus pseudarthrosis: aclinical rarity. Unfallchirurg 103(6):499–5034. Hoogendoorn JM, Simmermacher RK, Schellekens PP, van derWerken C (2002) Adverse eVects if smoking on healing of bonesand soft tissues. Unfallchirurg 105(1):76–815. Howard JL, Buckley R, McCormack R, Pate G, Leighton R, PetrieD, Galpin R (2003) Complications following management ofdisplaced intra-articular calcaneal fractures: a prospectiverandomized trial comparing open reduction internal Wxation withnonoperative management. J Orthop Trauma 17(4):241–2496. Karakurt L, Yilmaz E, Incesu M, Serin E (2004) Pseudarthrosis ofa calcaneus fracture; a case report. Acta Orthop Traumatol Turc38(4):288–2907. Lim EVA, Leung JPE (2001) Complications of intraarticular cal-caneal fractures. Clin Orthop 391:7–168. Sanders R (2000) Displaced intra-articular fractures of the calca-neus. J Bone Joint Surg Am 82(2):225–2509. Schepers T, Schipper IB, Vogels LMM, Ginai AZ, Mulder PGH,Heetveld MJ, Patka P (2007) Percutaneous treatment of displacedintra-articular calcaneal fractures. J Orthop Sci 12(1):22–2710. Thermann H, Hufner T, Schratt HE, Held C, Tscherne H (1999)Subtalar fusion after conservative or surgical treatment of calca-neus fracture. A comparison of long-term results. Unfallchirurg102(1):13–2211. Thomas P, Wilson LF (1993) Non-union of an os calcis fracture.Injury 24(9):630–63212. Zwipp H, Rammelt S (2006) Subtalar arthrodesis with calcaneusosteotomy. Orthopade 35:387–40413. Zwipp H, Rammelt S, Barthel S (2004) Calcaneal fractures–openreduction and internal Wxation (ORIF). Injury 35(Suppl 2):SB46–SB54123

Calcaneal nonunion: Three cases and a review of the literature

Schepers, Tim

Patka, Petr

EUR Research Repository

Calcaneal nonunion: three cases and a review of the literature

Crossref

Springer - Publisher Connector

Arch Orthop Trauma Surg (2008) 128:735–738  
DOI 10.1007/s00402-007-0516-3
TRAUMA SURGERY
Calcaneal nonunion: three cases and a review of the literature
Tim Schepers · Peter Patka 
Received: 25 May 2007 / Published online: 15 December 2007
©  The Author(s) 2007
Abstract The long-term follow-up of intra-articular
calcaneal fractures is often accompanied by complications.
Frequently occurring are arthrosis, arthroWbrosis of the
subtalar joint, and malunion. Uncommon is the calcaneal
nonunion. A total of three cases is presented in this report,
including a review of the literature. The occurrence of a
nonunion appears to be more common after conservative
treatment, but the pathophysiology remains unclear, how-
ever smoking may play a role.
Keywords Calcaneus · Fracture · Pseudarthrosis · 
Nonunion
Introduction
During long-term follow-up after intra-articular calcaneal
fractures complications frequently occur. In clinical
practice, arthrosis and arthroWbrosis of the subtalar joint,
malunion and nonunion are encountered [8, 12]. Nonunion
is only rarely found, and studies concerning complica-
tions after intra-articular calcaneal fractures do not
describe this complication [5, 7]. In only Wve studies,
including nine patients, reports on nonunion are made [3, 6,
10, 11, 13]. Three patients with a pseudarthrosis after an
intra-articular fracture of the calcaneus are presented in
the current study.
Cases
Case 1
A male adult (age 49) fell from a height of 2 m fracturing
his left calcaneus. According to the Essex–Lopresti classiW-
cation he sustained a joint-depression type, and a type IIA
fracture according to the Sanders classiWcation. There was
no injury to the soft tissues. After 6 days the fracture was
operated on, using percutaneous reduction and Wxation
according to the technique of Forgon and Zadravecz [9].
Post-operative treatment consisted of active range of
motion exercises and 3 months non-weight bearing. Initial
recovery was uncomplicated. Two years after the trauma,
the patient however returned to our outpatient department
with complaints of painful walking, and unable to work. A
computed tomography (CT) scan showed a pseudarthrosis
of the calcaneus and talocalcaneal joint surface incongru-
ence (Fig. 1). An injection of 10 cc lidocain in the subtalar
joint temporarily reduced pain. A subtalar joint arthrodesis
was performed, fusing the talus and calcaneus with the use
of bone graft gained from the iliac crest. After 1 year the
arthrodesis has fully consolidated, the patient is pain free,
but has currently not yet returned to work.
Case 2
A female patient, aged 53, sustained a fracture of the right
calcaneus after a fall from the stairs (Essex–Lopresti joint
depression type, Sanders type IIB). As patient was seen
three weeks after the trauma, the initial treatment was con-
servatively, consisting of 1 week of plaster-of-Paris and
3 months non-weight bearing with active range of motion
exercises. Two months later the patient was unable to bear
weight at the fractured side due to pain. A CT showed a
T. Schepers (&) · P. Patka
Department of Surgery-Traumatology, Erasmus MC, 
University Medical Center Rotterdam, Room H 974, 
Rotterdam  3000 CA, The Netherlands
e-mail: t.schepers@erasmusmc.nl123
736 Arch Orthop Trauma Surg (2008) 128:735–738delayed union of the calcaneus (Fig. 2). Peroperatively,
6 months after trauma, there was a nonunion of the fracture,
without apparent signs of arthrosis of the talocalcaneal joint
surface. Because of the smoking habits and diabetes in this
patient, as independent causes of high wound complication
rates, an early subtalar arthrodesis with bone graft har-
vested from the tibial tuberosity was performed instead of a
correcting osteotomy. Three months after the salvage
operation the arthrodesis had consolidated, the patient is
walking pain free.
Case 3
A male adult, of 39-years-old, sustained a bilateral calca-
neal fracture after jumping of a Wrst storey balcony. The
radiographs showed a comminuted intra-articular calcaneal
fracture according to the Essex–Lopresti classiWcation at
both sides and Sanders type IIC and IIIAC fractures on the
left and right foot, respectively. Initial treatment was con-
servative, consisting of 1 week of plaster-of-Paris and
3 months non-weight bearing with active range of motion
exercises. Thirteen months later the patient returned to the
outpatient department with complaints of pain at the left
heel. Additional radiographs and CT showed a nonunion of
the fracture of the left calcaneus (Fig. 3). A subtalar
arthrodesis was performed, with bone graft from the tibial
tuberosity. Two cannulated screws were inserted from the
tuberosity of the calcaneus, bridging the primary fracture
line. The after treatment was complicated with a superWcial
infection, which could be treated adequately with intrave-
nous antibiotics. Six months after the secondary fusion the
patient was able to walk pain free.
Discussion
Improper healing after an intra-articular calcaneal fracture
carries a high morbidity. Three groups: A, malunion; B,
nonunion; and C, osteonecrosis, were suggested by Zwipp
[13]. These groups are further divided according to the
presence of joint incongruence, varus/valgus, loss of height,
translation of bones and luxation. Treatment of these
Fig. 1 a Case 1: Axial CT-scan image 22 months after percutaneous reduction and Wxation showing nonunion; b Sagittal view
Fig. 2 a Case 2: Semi-coronal CT-scan image 5 months after conservative treatment showing delayed union; b Sagittal view123
Arch Orthop Trauma Surg (2008) 128:735–738 737complications after intra-articular calcaneal fractures
depends upon the presence of these conditions [13].
The Wrst written report on calcaneal fracture nonunion
was by Thomas (1993). He presented a 36-year-old female
patient, treated non-operatively, who developed a calcaneal
nonunion after 6 months [11]. A correction of the displaced
fragment was performed and stabilized using plate osteo-
synthesis and bone graft. The patient was able to fully bear
weight 12 weeks after this procedure.
Gehr described a 38-year-old male patient with an intra-
articular, comminuted fracture of the calcaneus [3]. This
fracture was treated with open reduction and internal plate
osteosynthesis. After removal of the plate at 18 months the
patient returned to the clinic with local swelling and pain
during walking. A nonunion was seen and a correction
osteotomy was performed with bone graft and screw Wxa-
tion. The fracture showed healing at 8 weeks.
Karakurt et al. [6] presented one 42-year-old male
patient with a nonunion of the calcaneus after conservative
treatment. The patient sustained a comminuted, open calca-
neal fracture which was treated in plastercast for 6 months.
Eight months after trauma the patient was unable to walk
without crutches because of severe pain of the heel. After
removing Wbrotic tissue the calcaneus was Wlled with bone
graft. Eight months after the operation patient was able to
walk and work without pain.
Zwipp and Rammelt [13] reported two patients with a
nonunion of the calcaneus. A 61-year-old female patient,
with a Sanders IIC fracture with a luxation of the tuberosity
fragment, was treated conservatively. An arthrodesis of the
subtalar and calcaneocuboid joint was performed 6 months
after trauma. Postoperatively the American Orthopaedic
foot and Ankle Society hindfoot score improved signiW-
cantly, compared with pre-operative values. The second
patient was a 45-year-old female polytrauma patient. After
percutaneous reduction and Wxation she was diagnosed
with a nonunion 1 year after the trauma, for which a subta-
lar joint arthrodesis was performed. No data on outcome
was provided in this case.
From cases described in literature and in the current
report no similarities that could indicate a risk factor of
nonunion could be found. There are no apparent similarities
besides the nonunion (Table 1). There might be a trend of
nonunion occurring after conservative treatment, suggesting
Fig. 3 a Case 3: Semi-coronal CT-scan image 13 months after conservative treatment showing nonunion; b Sagittal view
Table 1 Summary of patients 
presented in the literature after a 
calcaneal nonunion
Study Gender Age Initial treatment Salvage procedure Follow-up*
(months)
Thomas and Wilson [11] Female 36 Conservative Osteotomy, plate, bone graft 3
Thermann et al. [10] – – – Subtalar arthrodesis 62
Gehr et al. [3] Male 38 ORIF Osteotomy, screws, bone graft 2
Karakurt et al. [6] Male 42 Conservative Bone graft 8
Zwipp and Rammelt [12] Female 61 Conservative Subtalar arthrodesis, 
calcaneocuboid joint fusion
–
Female 45 Percutaneous Subtalar arthrodesis –
Current study Male 49 Percutaneous Subtalar arthrodesis 14
Female 53 Conservative Subtalar arthrodesis 3
Male 39 Conservative Subtalar arthrodesis 6* The follow-up period after the 
salvage procedure is given123
738 Arch Orthop Trauma Surg (2008) 128:735–738that less rigid or no Wxation may play a role in causing
fracture nonunion in the calcaneus. However Howard et al.
[5] saw no cases of nonunion in a group of 164 intra-articu-
lar calcaneal fractures treated nonoperative. Patient age var-
ied between 36 and 61, both sexes were aVected equally
often and initial treatment diVered between patients. Kara-
kurt et al. [6] suggested that smoking could be the cause of
the nonunion. All patients in this report were smokers. For
tibial fractures strong evidence exists for delayed fracture
healing in smokers [4]. And a signiWcant lower union-rate
was seen after subtalar arthrodesis in smokers versus non-
smokers [2]. Assous et al. [1] however saw no diVerence in
fracture healing between smokers and non-smokers in a
small series of intra-articular calcaneal fractures treated
operatively.
In contrast to the infrequent occurrence of the calcaneal
nonunion, stated in the case reports above, Thermann et al.
[10] describe an in incidence of 10% nonunion (n = 4/40) in
a group of patients receiving a subtalar arthrodesis for per-
sisting invalidating pain after an intra-articular calcaneal
fracture. In these four patients the nonunion coincided with
painful subtalar posttraumatic arthrosis, delineating the
indication for a subtalar arthrodesis, instead of a correction
osteotomy with internal Wxation.
Calcaneal nonunion has been reported on infrequently in
the literature, but the number of patients seen by Thermann,
and our own series, suggests that the incidence might be
higher than expected.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which
permits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
References
1. Assous M, Bhamra MS (2001) Should Os calcis fractures in smok-
ers be Wxed? A review of 40 patients. Injury 32(8):631–632
2. Easley ME, Trnka HJ, Schon LC, Myerson MS (2000) Isolated
subtalar arthrodesis. J Bone Joint Surg Am 82(5):613–624
3. Gehr J, Schmidt A, Friedl W (2000) Calcaneus pseudarthrosis: a
clinical rarity. Unfallchirurg 103(6):499–503
4. Hoogendoorn JM, Simmermacher RK, Schellekens PP, van der
Werken C (2002) Adverse eVects if smoking on healing of bones
and soft tissues. Unfallchirurg 105(1):76–81
5. Howard JL, Buckley R, McCormack R, Pate G, Leighton R, Petrie
D, Galpin R (2003) Complications following management of
displaced intra-articular calcaneal fractures: a prospective
randomized trial comparing open reduction internal Wxation with
nonoperative management. J Orthop Trauma 17(4):241–249
6. Karakurt L, Yilmaz E, Incesu M, Serin E (2004) Pseudarthrosis of
a calcaneus fracture; a case report. Acta Orthop Traumatol Turc
38(4):288–290
7. Lim EVA, Leung JPE (2001) Complications of intraarticular cal-
caneal fractures. Clin Orthop 391:7–16
8. Sanders R (2000) Displaced intra-articular fractures of the calca-
neus. J Bone Joint Surg Am 82(2):225–250
9. Schepers T, Schipper IB, Vogels LMM, Ginai AZ, Mulder PGH,
Heetveld MJ, Patka P (2007) Percutaneous treatment of displaced
intra-articular calcaneal fractures. J Orthop Sci 12(1):22–27
10. Thermann H, Hufner T, Schratt HE, Held C, Tscherne H (1999)
Subtalar fusion after conservative or surgical treatment of calca-
neus fracture. A comparison of long-term results. Unfallchirurg
102(1):13–22
11. Thomas P, Wilson LF (1993) Non-union of an os calcis fracture.
Injury 24(9):630–632
12. Zwipp H, Rammelt S (2006) Subtalar arthrodesis with calcaneus
osteotomy. Orthopade 35:387–404
13. Zwipp H, Rammelt S, Barthel S (2004) Calcaneal fractures–open
reduction and internal Wxation (ORIF). Injury 35(Suppl 2):SB46–
SB54123


The long-term follow-up of intra-articular calcaneal fractures is often accompanied by complications. Frequently occurring are arthrosis, arthrofibrosis of the subtalar joint, and malunion. Uncommon is the calcaneal nonunion. A total of three cases is presented in this report, including a review of the literature. The occurrence of a nonunion appears to be more common after conservative treatment, but the pathophysiology remains unclear, however smoking may play a rol

Patka, Peter

NARCIS 

Adverse eVects if smoking on healing of bones and soft tissues.

Calcaneal fractures–open reduction and internal Wxation (ORIF). Injury 35(Suppl 2):SB46– SB54

Calcaneus pseudarthrosis: a clinical rarity.

Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal Wxation with nonoperative management.

Complications of intraarticular calcaneal fractures.

Displaced intra-articular fractures of the calcaneus.

Isolated subtalar arthrodesis.

Non-union of an os calcis fracture.

Percutaneous treatment of displaced intra-articular calcaneal fractures.

Pseudarthrosis of a calcaneus fracture; a case report.

Should Os calcis fractures in smokers be Wxed? A review of 40 patients.

Subtalar arthrodesis with calcaneus osteotomy.

Subtalar fusion after conservative or surgical treatment of calcaneus fracture. A comparison of long-term results.

Calcaneal nonunion: three cases and a review of the literature

Abstract

Similar works

Full text

Available Versions

Erasmus University Digital Repository

EUR Research Repository

EUR Research Repository

Crossref

Springer - Publisher Connector

NARCIS