Intra-articular Calcaneus Fractures: Current Concepts Review

Abstract

Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular involvement of the posterior facet of the calcaneus. Intra-articular calcaneal fractures are challenging injuries to manage for both patients and surgeons given their association with both early and late complications. This article aims to review the management, classification systems, surgical approaches, and care regarding intra-articular calcaneal fractures. A review of the current literature yielded treatment strategies that aim to reduce complications such as soft tissue injury or loss of articular reduction while maintaining satisfactory clinical outcomes. The purpose of this article is to review these current concepts in the management of intra-articular calcaneal fractures. Level of Evidence: Level V, expert opinion.

Computed Tomography for Calcaneal Fractures: Adding Value to the Radiology Report

“…Fractures that require medial/combined approaches or lead to more difficulty with reduction will increase intraoperative time and are less likely to result in surgical success. [ 3 , 7 , 8 ] The flat nature of the lateral calcaneal wall allows easier surgical access and direct visualization of intra-articular fractures, but is associated with higher wound and infectious complications. The medial wall of the calcaneus is associated closely with the posterior tibial neurovascular bundle and its branches making the surgical approach challenging.…”

“…The medial wall of the calcaneus is associated closely with the posterior tibial neurovascular bundle and its branches making the surgical approach challenging. [ 3 , 8 ]…”

“…[ 10 ] The posterior heel is at risk of subsequent pressure necrosis due to compromised blood supply, and thus requires urgent surgical management. [ 3 , 8 , 11 ] Underlying smoking history and comorbidity (such as diabetes mellitus or peripheral vascular disease) may also worsen this condition and wound healing post-operatively.…”

“…[ 1 ] Some authors even advocate postponing surgery until the wound demonstrates signs that portend good wound healing. [ 8 ]…”

“…[ 3 , 7 ] Surgical approaches can be divided broadly into extensile lateral approach (ELS), which is the most commonly used one, medial approach, or other minimally invasive surgeries. [ 3 , 8 ]…”