Calcaneus fractures: facts, controversies and recent developments

Area of Science:

• Orthopedic Surgery
• Trauma Management
• Reconstructive Surgery

Background:

• Calcaneus fractures and associated soft tissue injuries present significant surgical challenges.
• Open reduction and internal fixation (ORIF) with a lateral plate is a standard treatment for displaced intra-articular fractures.
• Achieving anatomical reduction and joint congruity are critical for favorable outcomes.

Purpose of the Study:

• To review current management strategies for calcaneus fractures.
• To highlight prognostic factors influencing treatment outcomes.
• To discuss surgical approaches and alternatives for complex cases and malunions.

Main Methods:

• Review of established surgical techniques for calcaneus fracture management.
• Discussion of prognostic indicators and factors affecting treatment success.
• Evaluation of different surgical approaches, including extended lateral and percutaneous fixation.
• Consideration of management for open fractures, compartment syndrome, and malunions.

Main Results:

• ORIF provides good to excellent results in 66-75% of cases for displaced intra-articular fractures.
• Bone grafting is generally not necessary.
• Factors like open fractures, delayed reduction (>14 days), high BMI, and smoking negatively impact results.
• The extended lateral approach offers good exposure, while percutaneous fixation is an alternative for selected cases.

Conclusions:

• Anatomical reduction and timely intervention are key to successful calcaneus fracture management.
• The extended lateral approach is effective, with percutaneous fixation as a viable alternative.
• Complex open fractures require emergency treatment and early soft tissue coverage.
• Staged protocols can successfully treat disabling calcaneal malunions.