The operative treatment of fractures of the os calcis

Displaced intra-articular fractures of the body of the os calcis are notorious causes of significant and prolonged disability. Treatment recommendations for these injuries have varied widely. An understanding of the anatomy and pathomechanics of the injury is important in treatment selection. Tongue-type and joint depression-type calcaneal fractures are subdivided on the basis of relations of the primary fracture line to the posterior facet. Treatment regimens are also based upon these relations and fracture classification. Choice of surgical approach depends upon the fracture pattern, including secondary comminution. The goal of operative treatment is to reestablish articular congruency, calcaneal width, and early range of motion. Operative treatment can be recommended for fractures that can be accurately reduced and rigidly transfixed. Nonoperative treatment is recommended for those fractures where accurate reduction is unattainable.