Overview
Calcaneus fractures, often resulting from high-energy trauma, pose significant challenges due to their complex anatomy and potential for long-term disability 1. These fractures frequently involve the subtalar joint and can disrupt critical anatomical structures like the sustentaculum tali 2.Diagnosis
Key Diagnostic Criteria: Lateral, Anthonsen oblique, anterior-posterior, and axial radiographs are essential for comprehensive assessment 6.
Recommended Tests: CT imaging is crucial for detailed fracture pattern analysis, particularly Sanders classification 2.
Grading: Sanders classification system categorizes fractures into types 1-4 based on fracture location and displacement 2.
Radiographic Indicators: Bohler's Angle (BA) and Critical Angle of Gissane (CAG) measurements can aid in diagnosis but have limitations in emergency settings 5.Management
First-Line Treatment: Open reduction and internal fixation (ORIF) with bone grafting, followed by early mobilization, yield optimal outcomes 6.
Fixation Techniques: Various fixation methods exist, with cadaveric studies highlighting biomechanical and anatomical considerations crucial for surgical planning 1.
Postoperative Care: Early mobilization typically begins around six to eight weeks post-surgery to prevent stiffness 6.
Soft Tissue Management: During lateral approaches, careful release of soft tissues, including those attached to the superior peroneal retinaculum, is necessary without risking peroneal tendon dislocation 4.Special Populations
Pregnancy: Specific management considerations for pregnant patients are not addressed in the provided abstracts.
Pediatrics: No specific guidelines or studies addressing calcaneus fractures in pediatric populations are mentioned.
Elderly: Elderly patients may require tailored rehabilitation due to comorbidities, though specific recommendations are not detailed in the abstracts.
Comorbidities: Management should consider associated lumbar spine injuries, especially in high-energy trauma cases 6.Key Recommendations
Utilize comprehensive radiographic imaging (lateral, Anthonsen oblique, AP, axial views) for accurate diagnosis of calcaneus fractures (Evidence: Strong 6).
Employ open reduction and internal fixation with bone grafting for optimal functional outcomes, initiating early mobilization around six to eight weeks post-surgery (Evidence: Moderate 6).
Carefully release soft tissues during surgical approaches to visualize all fracture fragments without causing peroneal tendon dislocation (Evidence: Moderate 4).
Consider CT imaging for detailed fracture pattern analysis, particularly for surgical planning (Evidence: Moderate 2).
Be cautious with reliance on Bohler's Angle and Critical Angle of Gissane for emergency diagnosis due to limited utility (Evidence: Weak 5).References
1 Pang J, Hussain A, Yan M, Kapur K, Solomou G, Brassett C et al.. The cadaveric research model for calcaneus fractures: A scoping review of biomechanical, anatomical, radiographic and fracture fixation studies. Foot (Edinburgh, Scotland) 2024. link
2 Sani G, Giabbani N, Zanna L, Buzzi R, Pio AS, Rastrelli V et al.. The impact of sustentaculum tali fracture on clinical outcome in patients affected by isolated calcaneal fractures. European journal of orthopaedic surgery & traumatology : orthopedie traumatologie 2024. link
3 Guo J, Mu Y, Xue D, Li H, Chen J, Yan H et al.. Automatic analysis system of calcaneus radiograph: Rotation-invariant landmark detection for calcaneal angle measurement, fracture identification and fracture region segmentation. Computer methods and programs in biomedicine 2021. link
4 Vosoughi AR, Tamadon A, Gholamzadeh S, Fereidooni M. Can We Release All Calcaneal Attachments of the Superior Peroneal Retinaculum During Extensile Lateral Approach to the Calcaneus?. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 2021. link
5 Knight JR, Gross EA, Bradley GH, Bay C, LoVecchio F. Boehler's angle and the critical angle of Gissane are of limited use in diagnosing calcaneus fractures in the ED. The American journal of emergency medicine 2006. link
6 Horn CE. Fractures of the calcaneus. Diagnosis and treatment. California medicine 1968. link