This paper defines the pathological anatomy of displaced intra-articular calcaneal fractures using plain radiographs and CT in 120 consecutive cases. It proposes a three-type classification based on which fragments compose the fractured lateral wall, determinable from a single coronal CT cut. The classification is a surgical planning tool for lateral approach ORIF.
For decades, calcaneal fracture reduction was taught as 'elevating the depressed lateral fragment,' based on a fracture pattern Malgaigne described in 1843. Eastwood's CT analysis of 120 consecutive cases showed that pattern occurs in fewer than 1 in 14 patients.
When you see a displaced intra-articular calcaneal fracture, get a coronal CT cut at the level of the lateral malleolus before planning your approach. The composition of the lateral wall tells you what you will face: Type 1 gives you direct access, Type 2 often requires partial osteotomy, and Type 3 always requires a formal lateral wall osteotomy to expose the impacted lateral joint fragment.
The correct reduction sequence is to disimpact the body fragment downward with varus correction, then reduce both the lateral joint and sustentacular fragments onto it. Simple elevation of the lateral fragment will fail in Types 1 and 2.
With a mean 41% of the subtalar articular surface on the lateral joint fragment regardless of type, anatomic reduction of that fragment is not optional — this paper is why lateral approach ORIF targets it directly.
This paper defines the pathological anatomy of displaced intra-articular calcaneal fractures using plain radiographs and CT in 120 consecutive cases. It proposes a three-type classification based on which fragments compose the fractured lateral wall, determinable from a single coronal CT cut. The classification is a surgical planning tool for lateral approach ORIF.
For decades, calcaneal fracture reduction was taught as 'elevating the depressed lateral fragment,' based on a fracture pattern Malgaigne described in 1843. Eastwood's CT analysis of 120 consecutive cases showed that pattern occurs in fewer than 1 in 14 patients.
When you see a displaced intra-articular calcaneal fracture, get a coronal CT cut at the level of the lateral malleolus before planning your approach. The composition of the lateral wall tells you what you will face: Type 1 gives you direct access, Type 2 often requires partial osteotomy, and Type 3 always requires a formal lateral wall osteotomy to expose the impacted lateral joint fragment.
The correct reduction sequence is to disimpact the body fragment downward with varus correction, then reduce both the lateral joint and sustentacular fragments onto it. Simple elevation of the lateral fragment will fail in Types 1 and 2.
With a mean 41% of the subtalar articular surface on the lateral joint fragment regardless of type, anatomic reduction of that fragment is not optional — this paper is why lateral approach ORIF targets it directly.