Calcaneus

10.1055/b-0034-87666

Calcaneus

Classifications

The AO/ICI classification 597
The Sanders classification 598
The Essex-Lopresti classification 599

Introduction

22.1 Calcaneus—introduction Hans Zwipp, Stefan Rammelt 601
1 Introduction 601
1.1 Minimally invasive osteosynthesis and general management of calcaneal fractures 601
1.2 Indications for operative treatment 601
1.3 Conventional treatment methods: conservative versus surgical 601
1.4 Different methods of fixation 602
1.5 Is there a place for MIO in fixation of calcaneal fractures? If so, what are the advantages and disadvantages? 602
1.6 Indications and contraindications for MIO 602
2 Surgical anatomy 603
2.1 Special aspects for calcaneus 603
3 Preoperative assessment 604
3.1 Fracture and soft-tissue assessment 604
3.2 Type of x-rays and CT scans 604
3.3 Choice of implants 604
3.4 Timing of surgery 604
3.5 Preoperative planning 604
4 Operating room setup 605
4.1 Anesthesia 605
4.2 Patient and of image intensifier positioning 605
4.3 Implants and instruments 605
5 Operative procedure 606
5.1 Surgical approach 606
5.2 Reduction techniques 606
5.3 Role of arthroscopically assisted surgery 606
5.4 Fixation techniques 608
5.5 Intraoperative evaluation 609
6 Postoperative treatment 609
7 Complications 609
7.1 Salvage in failed MIO 609
7.2 Other complications 609
8 Pitfalls 610
9 Pearls 610
10 Results 610
11 The future 611
12 References 611

Cases

22.2 Double-sided calcaneal fracture—AO/ICI type B1, Sanders type II Hans Zwipp, Stefan Rammelt 613
22.3 Displaced, intraarticular calcaneal fracture—AO/ICI type B1, Sanders type III Hans Zwipp, Stefan Rammelt 619

Classifications

The calcaneus is number 81.2 according to the AO/ICI classification. Four types of calcaneal injuries are described: extraarticular (81.2A), intraarticular (81.2B), fracture dislocation (81.2C), and pure dislocation (81.2D). The three fracture subtypes describe the number of joint facets that are fractured. The joint injured is labeled in square brackets. For example, [d] = posterior facet of the subtalar joint, [e/f] anterior/medial facet of the subtalar joint, and [h] calcaneocuboideal joint.

Three further numbers in round brackets placed after the classification of the joint injury describe the tissues (bone, cartilage, soft tissues) that are involved, the kind of fracture that is present, and the amount of displacement. In this way the classification precisely describes the fracture and this feature is invaluable when fractures need to be described accurately for scientific studies [ 1].

The AO/ICI classification

Although the AO/ICI classification is the most comprehensive the most widely used classification is that of Sanders [ 2], which is based on the number and location of fracture lines in the coronal CT scans at the level of the posterior calcaneal facet. Extraarticular and nondisplaced fractures are classified as type I; the presence of one fracture line is classified as type II, the presence of two fracture lines is classified as type III, and the presence of three or more fracture lines is classified as type IV. Laterally situated fracture lines are given the letter A, intermediately situated fracture lines are given the letter B, and medial fracture lines are given the letter C. This classification is easy to use and of prognostic value. The amount of displacement, the involvement of the calcaneocuboidal joint, and the degree of soft-tissue damage are not described by this classification.

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