Dr. Ebraheim’s educational animated video describes Intra - Articular fractures classifications of the calcaneus.
General considerations for Calcaneal fractures:
1-Evaluate the soft tissue conditions and delay the surgery if the soft tissue condition is not optimal.
2-Evaluate the spine for compression fractures, Calcaneal fractures usually occur from a fall.
3-Evaluate the foot for compartment syndrome
Open fractures are bad and may lead to amputation. Avulsion fractures of the Achilles tendon may endanger the skin, it needs urgent reduction and treatment.
Axial CT scan cuts will show the calcaneocuboid joint and the peroneal tendon condition.
The intra-articular Calcaneal fractures constitute 70-75% of all fractures. Sanders classification is widely used and predictive of results. There are four fracture types based on the number and location of the articular fragments. Coronal CT scan is used to show the widest part of the posterior facet. There primary fracture lines (A,B,C) through the posterior facet divide the calcaneus into four fragments (lateral, central, medial and sustentacular).
Type I: all nondisplaced articular fractures (2 mm) irrespective of the number of fracture lines.
Type II: two-part fracture of the posterior facet. Subtypes: IIA,IIB,IIC, based on the location of the primary fracture line.
•Type IIA: two-part fracture of the posterior facet, with primary fracture line A is lateral.
•Type IIB: two-part fracture of the posterior facet, with primary fracture line B is central.
•Type IIC: two-part fracture of the posterior facet, with primary fracture line C is medial.
Type III: three-part fracture of the posterior facet, with a centrally depressed fragment. Subtypes: IIIAB, IIIAC, IIIBC, based on the location of the primary Fracture.
•Type IIIAB: three-part fracture of the posterior facet with a centrally depressed fragment with primary fracture lines A and B.
•Type IIIAC: three-part fracture of the posterior facet with a centrally depressed fragment with primary fracture lines A and C.
•Type IIIBC: three-part fracture of the posterior facet with a centrally depressed fragment with primary fracture lines B and C.
Type IV: Four-part articular fractures, highly comminuted.
The higher the fracture number, the worse the result.
The sustentacular fracture is a constant fragment that remains attached to the talus through ligaments. During surgery the displaced articular and tuberosity fragments are reduced to the sustentacular fragment and the varus of the calcaneus is corrected.
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