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Surgical treatment of the intra-articular calcaneus fracture.

The acute displaced intra-articular calcaneus fracture should be approached on a rational basis. Minimally displaced fractures are best treated with early motion and delayed bearing of weight. Reconstructible, displaced fractures are probably best treated with exact open reduction and internal fixation, assuming contraindications such as poor skin condition or underlying disease are not present. The severely displaced, Sanders-type IV fractures remain a dilemma, and these may demonstrate a role for primary fusion in select instances. If one chooses to treat a calcaneus fracture surgically, it should be recognized that the result will be related to the exactness of the reduction. This surgery is very challenging, with an arduous learning curve. Importantly, if one cannot obtain an anatomic reduction, the patient may have been better off treated nonoperatively.