Acute intra-articular calcaneal fractures: currents concepts

Calcaneal fractures are predominantly intra-articular and most commonly involve the subtalar joint, with an estimated incidence of 11,5 per 100,000 population and a male predominance. They occur mainly after high-energy trauma and are associated with substantial functional impairment and major socio-occupational consequences. Anatomical assessment (loss of height, posterior facet collapse, lateral wall widening, and varus displacement with superior migration of the tuberosity) determines prognosis and guides management. Plain radiographs (Böhler's and Gissane's angles) remain useful, but computed tomography is the reference standard for lesion characterization and preoperative planning. The surgery-versus -conservative debate has shifted with the development of minimally invasive techniques (sinus tarsi approach, percutaneous screw fixation and intramedullary nailing), which aim to restore hindfoot alignment, articular congruence and stability while reducing soft-tissue morbidity. Displaced Sanders II-III fractures represent the main indications for osteosynthesis, whereas Sanders type IV fractures are typically discussed between ORIF and primary subtalar arthrodesis. The most frequent complications remain soft tissue compromise and infection, as well as late sequelae (subtalar osteoarthritis, lateral subfibular impingement and residual varus). Current innovations focus on improving the reproducibility of reduction (arthroscopy-assisted techniques, balloon calcaneoplasty and navigation/robotics).