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97° CONGRESS OF THE PIEDMONTESE-LIGURIAN-LOMBARD SOCIETY OF ORTHOPEDICS AND TRAUMATOLOGY (SPLLOT) - II (Alba, September 22-23, 2000)
The unfortunately frequent complications of articular fractures of the calcaneous represent a high social impact problem, because of the frequent and long invalidity. The long-term problems, not only related to the possible degenerative evolution of the subtalar joint, are directly related to the whole complex deformation produced at the moment of the fracture event. The ''in acute'' treatment is, therefore, determinant in the minimization of the ''secondary (hesitate)'' problems and must be established the reconstruction of the global shape of the calcaneous bone. The relevant problems are represented by the axial deviations of the calcaneous on its frontal, horizontal and, the less noticed, sagittal planes; this last one enhances the functional limitation of the tibiotalar joint and is the cause of a possible painful syndrome of the distal tibio-fibular sindesmosis. The possible secondary presence, of nervous branch compression (tibialis or sural nerves), of fibulo-calcaneal bony-conflict, plantar osseous protrusion, toe retraction is underlined. All these problems, in an isolated or combined way, or added to the painful rigidity of the subtalar joint, are present in a different rate in the cases illustrated in this work. The treatment represents sometimes an important surgical problem and with very uncertain results, while the surgical stabilization of subtalar joint, in absence of other problems, is not difficult to be performed. For all this we think that it is very important to remind that must be considered as a ''critical factor'' the whole complex deformation produced by the trauma and not only the damage of subtalar joint that compromises the talus.