This 2004 narrative review by Rammelt and Zwipp synthesizes 150 years of calcaneus fracture management into current standards and controversies. It covers pathomechanics, classification systems, surgical indications, approaches, complications, and treatment of malunions. The central question is when to operate, how, and what determines a good result.
The 14-day rule is the most actionable number in this paper. When a displaced intra-articular calcaneus fracture arrives swollen and not yet operable, the clock is running — soft tissue windows close, consolidation begins, and outcomes measurably worsen after day 14.
When you see a Sanders Type II or III fracture with posterior facet displacement of 2 mm or more, the threshold for surgery is clear. The large multicenter RCT (n=424) shows the overall benefit is concentrated in specific subgroups: younger patients, women, those not receiving worker's compensation, and those who achieve anatomical reduction with a residual step-off under 2 mm.
For the swollen, compromised foot: temporize with elevation, ice, and early motion — but plan your ORIF before day 14. For the complex open fracture or compartment syndrome, treat as an emergency with debridement, provisional fixation, and staged definitive repair.
The Stephens-Sanders malunion classification gives you a decision tree for the neglected or conservatively treated fracture presenting years later with pain and deformity — match the type to the correction, and expect good outcomes even in salvage cases.
This 2004 narrative review by Rammelt and Zwipp synthesizes 150 years of calcaneus fracture management into current standards and controversies. It covers pathomechanics, classification systems, surgical indications, approaches, complications, and treatment of malunions. The central question is when to operate, how, and what determines a good result.
The 14-day rule is the most actionable number in this paper. When a displaced intra-articular calcaneus fracture arrives swollen and not yet operable, the clock is running — soft tissue windows close, consolidation begins, and outcomes measurably worsen after day 14.
When you see a Sanders Type II or III fracture with posterior facet displacement of 2 mm or more, the threshold for surgery is clear. The large multicenter RCT (n=424) shows the overall benefit is concentrated in specific subgroups: younger patients, women, those not receiving worker's compensation, and those who achieve anatomical reduction with a residual step-off under 2 mm.
For the swollen, compromised foot: temporize with elevation, ice, and early motion — but plan your ORIF before day 14. For the complex open fracture or compartment syndrome, treat as an emergency with debridement, provisional fixation, and staged definitive repair.
The Stephens-Sanders malunion classification gives you a decision tree for the neglected or conservatively treated fracture presenting years later with pain and deformity — match the type to the correction, and expect good outcomes even in salvage cases.