Calcaneus
Scenario
You are called to A+E to assess a 40 year old male who jumped from a wall and has sustained the following injury. He has no past medical history.
This is a lateral and anterior-posterior plane film radiograph of a patients ankle. There is a displaced tongue type calcaneal fracture.
Extra-articular (25%)
Intra-articular (75%)
- Essex-Lopresti classification
- Tongue type
- Joint depression type
- Sanders classification
- Based on the number of articular fragments seen on the coronal CT images at the widest point of the posterior facet.
Saunders classification | |
Type 1 | Non displaced posterior facet |
Type 2 | One fracture line in the posterior facet |
Type 3 | Two fracture lines in the posterior facet |
Type 4 | Comminuted with more than 3 fracture lines |
- Böhler’s lines (20-40°): angle between the highest point of the anterior facet to the highest point of the posterior facet and a line tangential to the superior edge of the tuberosity.
- Angle of Gissane (120-145°): Angle between line along lateral margin of posterior facet and line anterior to beak of calcaneus.
They represent collapse of the posterior facet.
Cast immobilisation non-weightbearing for 6 weeks (stress fractures)
Cast immobilisation non-weightbearing for 10-12 weeks
Cast immobilisation requires regular checks as there is a high incidence of skin complications.
Operative management can be either:
- Closed reduction and percutaneous pinning
- Open reduction + internal fixation
- Restore congruity of subtalar joint
- Restore Bohler’s angle and calcaneal height
- Restore width
- Correct varus
- Wound complications (smokers, diabetic and open fractures)
- Subtalar arthritis
- Sural nerve neuroma
- Lateral impingement with peroneal irritation
- Compartment syndrome
- Malunion
