The closed method of reduction of fractures of the os calcis has given us an exceedingly low functional foot loss. Kessler estimates that the most severe form of this fracture, which has been discussed as Type V, results in a minimum disability of 20-per cent. loss of function of the foot. There were only two instances in which even this minimum was exceeded and the average loss of function was only 12 per cent.
After healing has occurred, it is not uncommon to find that the architecture of the injured foot has been restored to an apparently normal condition, yet the patient may complain of varying degrees of pain, particularly below the malleoli. Pain on the plantar weight-bearing surface of the tuberosity is seldom as severe or as persistent as that which is found laterally, especially under the external malleolus.
The loss of motion in eversion and inversion constitutes the greatest type of residual disability.
The more severe associated vertebral injuries have occurred in Type-III fractures, in which the medial condyle of the tuberosity is split off, and not in the severe comminuted cases seen in Type 5.
Skeletal traction and extension separate the subastragaloid and the cuboid articular surfaces, and this procedure also restores the architecture which will permit the resumption of the normal mechanics in the foot for weight-bearing and locomotion.
In the series of cases upon which this paper is based, the youth of the patients, the promptness of first-aid attention, and the complete facilities provided for adequate care and early reduction of these fractures undoubtedly accounted in a large measure for the low residual disabilities obtained.
(C) 1936 All Rights Reserved.The Journal of Bone and Joint Surgery, Inc.