Grouping of intraarticular calcaneal fractures relative to treatment options

None of the classifications of intraarticular calcaneal fractures are comprehensive enough to accommodate all types of fractures. Of the 150 intraarticular calcaneal fractures, 37 could not be placed in the commonly used Sanders classification. These then were grouped according to where their primary fracture line was located in relation to the posterior calcaneal facet. Twenty-three fractures were anteromedial to the facet; 75% of these were of the tongue type and were amenable to being treated with the Essex-Lopresti method of reduction and placement of two screws. The joint depression type in this group required open reduction and internal fixation through the lateral approach. Eight fractures were located posterolateral to the facet. They were treated from the lateral or the medial approach. Six fractures crossed the facet transversely; these were treated percutaneously with placement of two lag screws. Clinically this grouping was helpful because it provided a guideline to appropriate treatment strategies for fractures that could not be accommodated in the Sanders classification.