Treatment for displaced sustentaculum tali fractures.

BACKGROUND: Sustentaculum tali fractures are rare foot fractures accounting for 1% of all calcaneal fractures, which accounts for about 1-2% of all bone fractures. Since the importance of sustentaculum tali in maintaining the medial foot arch, its fractures should be dealt with anatomical fixation to avoid post-traumatic arthrosis.

OBJECTIVE: Is to delineate the importance of sustentacular tali fractures fixation mentioning operative technique and the post-operative outcome.

METHODOLOGY: Ten cases with 10 consequent closed sustentaculum tali fractures were treated by ORIF. Nine of them were male gender. Patient's age was 27.6 (ranged 22-40). Of those 10 cases, 7 were isolated sustentaculum tali fractures, while 3 cases were associated by other fractures. All patients were followed-up with a follow-up period 52.8 months (ranged 24-84m).

RESULTS: All fractures were united with a union rate 100%. Union appeared radiologically between 6-8 weeks post-operatively with an average 6.8 weeks. Isolated sustentacular fractures achieved post-operative 100 score while in the case with fractured talar neck, patient had a score 80, associated distal fibular fracture achieved 90 score, overall average score was 97 ranged 80-100. There was no recorded complication regarding to the operative maneuver.

CONCLUSION: Fractures of the sustentaculum tali are rare injuries associated with high energy mechanisms. These fractures have a high incidence of misdiagnosis. A high index of suspicion is, therefore, required when there is pain and hematoma directly over the sustentaculum tali. Open reduction and internal fixation of these fractures is reliable and possible through a medial approach.