OBJECTIVETo discuss the characteristics and experience for surgical treatment of combined calcaneal fracture.

METHODSBetween February 2004 and September 2007, 17 feet of 13 patients with combined calcaneal fractures underwent surgical operations. Among 17 calcaneal fractures, 8 combined with ipsilateral talus fractures, 5 combined with trimalleolar fractures, 4 combined with Pilon fractures. Firstly, fractures of hinder foot were treatment with open reduction and internal fixation according to the principle. Of all, 15 fractures were treated with screws or titanic plate plus open reduction and internal fixation, the rest 2 fractures were treated with subtalar arthrodesis. Postoperative X-ray assessed the internal fixation and union of fractures. The foot function was evaluated by the Maryland Foot Score.

RESULTSA total of 13 patients were all followed up for 16.0 - 33.0 months (average 26.5 months), superficial infection was found in a patient with open wound 10 d after surgery. All the bone fractures united after surgery from 4 to 6 months. Morphous improvement of the calcaneal were proved by X-ray films and there here was no plates and screws' breakage, loosening. Mild osteoarthritis in Subtalar and ankle joints were found by X-ray after surgery from 9 months to last follow-up. Cystic degeneration and necrosis were found in 5 and 2 cases of talus fractures respectively. According to Maryland Foot Score, excellent was in 3 feet, good in 6 feet, fare in 5 feet and poor in 3 feet, with excellence rate of 52.9%.

CONCLUSIONSCombined calcaneal is a calcaneus-based concomitant ankle and foot fractures after a high-energy injury. Good deal of soft tissue and correct design of operation pre-operatively, restoration of form and power lines of calcaneal, effective bone graft, right place of simple internal fixation or subtalar arthrodesis and good reduction and internal fixation of other fracture in hinder feet intra-operatively and correct function postoperatively are key points to have a relatively satisfied treating effect of combined calcaneal fractures.