Calcaneal fractures: The orthopaedic challenge

Abstract

Calcaneal fractures, since their description in 1843 by Malgaigne, still remain a challenge in orthopaedic surgery. They are significant from an epidemiological point of view - they represent 60% of all tarsal fractures, and of an increasing number of fractures due to traffic accidents and their outcome is unpredictable. In contrast to the disappointing results after nonoperative treatment and at the beginnings of calcaneal surgery, the outcome is promising nowadays. New imaging and fixation devices, with proper classification and indication for certain surgical procedures have led to the improved outcome. But, there are still controversies, and we emphasize the most rationale treatment for the calcaneal fractures, as well as best surgical options.

Surgical Treatment of Calcaneal Fractures of Sanders Type II and III by a Minimally Invasive Technique Using a Locking Plate

“…The calcaneus is the most frequently fractured tarsal bone, representing 2% of all fractures and 60% of all tarsal fractures (1). These injuries can be extra-articular or intra-articular fractures, with intraarticular fractures constituting approximately 60% to 75% of all calcaneus fractures (2).…”

Osseous injuries of the foot: an imaging review. Part 3: the hindfoot

“…Calcaneal fractures are the most common tarsal fracture, accounting for up to 60% of all tarsal fractures 3. The mechanism of calcaneal injury is usually a fall, where an axial load forces the calcaneus to divide (figure 1).…”

“…The mechanism of calcaneal injury is usually a fall, where an axial load forces the calcaneus to divide (figure 1). This results in a sustentacular fragment and a tuberosity fragment as the dominant portions of the divided calcaneus 3. The sustentacular fragment remains stable in location due to the strong attachments of the deltoid ligaments.…”

“…In most cases, the lateral view will show depression of the posterior facet and a decrease in Bohler's angle (an imaginary line drawn from the most superior part of the posterior facet to the most superior part of the anterior facet, normally 20–40°) 2 3. In osteopenic or osteoporotic individuals with non-displaced fractures, close evaluation of the calcaneal trabeculae for discontinuity may be the only evidence of fracture on plain radiographs.…”

Minimizing Hardware in Intra-Articular Fracture Calcaneus

“…15 Calcaneus has an irregular bony anatomy, complicated joint mechanics, fragile soft tissue cover and a complex 3D anatomy. 16 Maintenance of the articular surface remains the primary goal of treatment.…”