1. Manipulation, skeletal traction, and subastragalar arthrodesis have heretofore inadequately solved the problem presented by squash fractures of the os calcis.
2. The failure of these various methods of treatment can be explained on a rational anatomical basis, centering about depression of the sustentaculum tali, a lesion which cannot be certainly recognized by the roentgenologist. An operative exposure has frequently disclosed serious articular disruption, when the roentgenograms were nearly or completely negative for joint involvement.
3. We have come to consider any appreciable loss of lateral motion in the subastragalar joint, or the presence of thickening and untoward bone on the external surface of the tuberosity of the os calcis, as diagnostic of disruption of all of the reciprocal articulations of the calcaneum, irrespective of the roentgenographic findings.
4. Finally, a plan of treatment more completely correcting the extensive anatomical distortion has been evolved, which includes a preliminary reduction by manipulation and skeletal traction, to be followed five weeks later by subastragalar, calcaneocuboid, and astragaloscaphoid fusions. In dealing with the late lesions, where obviously traction could be of no assistance, it has not been attempted and the treatment has been limited to a primary triple fusion.
(C) 1935 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.