5. • Calcaneal fracture are the most common
fractured tarsal bone and associated with a high
degree of morbidity and disability .
• Diagnosis is made radiographically with foot
radiographs with CT scan often being reqiured for
surgical planning .
• Treatment is nonoperative verses operative based
on fracture displacement , alignment , associated
soft tissues injury and patient with risk factors.
6. • Incidence
• Most frequent tarsal fracture
• 60-75% of injuries are intra articular fracture
• 1-3% are calcaneal tuberosity fracture
• 17% are open fracture
7. • Mechanism
• Intra articular fracture associated with
traumatic axial loading as a primary
mechanism of injury – fall from height and
motor-vehicle accidents
• Calcaneal tuberosity fractures associated with
poor bone quality /osteoporosis-violent
contraction of the triceps surae with forced
dorsiflexion
8. • Calcaneal stress fracture
• Increased physical activity in the setting of
relative energy deficiency
• Anterior process fracture
• Twisting injury mechanism
• Avulsion injury of the bifurcate ligament
9. • Fracture lines in calcaneal fracture
• Primary fracture line –runs obliquely through
posterior facet of calcaneum and divides the
fracture into 2 fragments
• Anteromedial fragment
• Posterolateral fragment
• Secondary fracture line –passes posterior to
posterior facet of calcaneum
10. • Classification of calcaneal fracture
• Extra articular (25%)
• Avulsion injury of
• Anterior process by bifurcate ligament
• Sustentaculum tali
• Calcaneal tuberosity ( Achilles tendon
avulsion)
11. • Intra articular (75%)
• Essex –lopresti classification
• Primary fracture line
• Secondary fracture line – Tongue type and
depression fracture
12. • Sanders classification –Based on the number of
articular fragments seen on the coronal CT scan
images at the widest point of the posterior facet
• Type 1 –Non displaced posterior facet
• Type 2 –One fracture line in the posterior facet (
two fragments )
• Type 3- Two fracture lines in the posterior facet (
three fragments )
• Type 4-Comminuted with more than three
fracture lines in the posterior facet (four or more
fragments )
13. • Beavis classification
• Based on fracture morphology of the calcaneal
tuberosity
• Type 1 – Sleeve fracture –small shell of cortical
bone avulses from the tuberosity
• Type 2-Beak fracture –oblique fracture runs
posteriorly from the most superior portion of the
posterior facet
• Type 3-Infrabursal fracture from the middle of the
tuberosity
14. • Clinical features
• Pain
• Swelling
• Inability to bear weight
• Gross deformity
• Open fractures
21. • MRI
• Indications
• Used only to diagnose calcaneal stress
fracture in the presence of normal
radiographs
22. • Treatment
• Non operative –
• Cast immobilisation with non weight bearing for 6 weeks for
Calcaneal stress fracture
• Cast immobilization with non weight bearing for 10-12 weeks
• Indications
• Small extra articular fracture less than 1 cm with intact Achilles
tendon and less than 2mm displacement
• Sander Type 1 (non displaced)
• Near normal bohler angle (20-40)
• Anterior process fracture involving less than 25% of calcaneocuboid
joint
23. • Operative
• Closed reduction with percutaneous pinning
• Indications
• Minimally displaced tongue type fracture
• Large extra-articular fracture more than 1cm
24. • ORIF indications
• Displaced tongue type fracture > 1cm
displacement
• Open fracture
• Large extra-articular fracture >2mm
displacement
• Sander type 2 and 3
25. • Primary subtalar arthrodesis
• Indications
• Sander type 4
• Technique –combined with ORIF to restore
height
26. • ORIF Approach
• Extensile lateral or medial approach
• Extensile lateral L-shaped incision is most
popular
• Sinus tarsi approach
• Goals of ORIF
• Restore congruity of subtalar joint
• Restore bohler angle and calcaneal height
• Restore width
27. • Complications
• Delayed wound healing is the most complication
• Subtalar arthritis
• Peroneal irritation
• Sural nerve neuroma
• Damaged FHL
• Compartment syndrome 10% results in claw toes
• Malunion – limited dorsiflexion
28. • Malunion of calcaneal fracture
• Classification based on CT
• Type 1 –Lateral exostosis with no subtalar
arthritis
• Type 2-Lateral exostosis with subtalar arthritis
• Type 3-Lateral exostosis with subtalar arthritis
and varus malunion
