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.
- 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.
Non displaced posterior facet
One fracture line in the posterior facet
Two fracture lines in the posterior facet
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