Calcaneal Fracture - Diagnosis

Diagnosis

Conventional radiography is usually the initial assessment tool when calcaneal fracture is suspected. Recommended x-ray views are (a) axial, (b) anteroposterior, (C) oblique views and (d) views with dorsiflexion and internal rotation of the foot. However, conventional radiography is limited for visualization of calcaneal anatomy, especially at the subtalar joint. CT Scan is currently the imaging study of choice for evaluating calcaneal injury and has substituted conventional radiography in the classification of calcaneal fractures. Axial and coronal views are taken for proper visualization of the calcaneus, subtalar, calcaneocuboid and talonavicular joints.

The Sanders Classification system is the most commonly used system for categorizing intrarticular fractures. There are 4 types:

1. Type I fractures are non-displaced fractures (displacement < 2 mm).
2. Type II fractures consist of a single intrarticular fracture that divides the calcaneus into 2 pieces.
   • Type IIA: fracture occurs on lateral aspect of calcaneus.
   • Type IIB: fracture occurs on central aspect of calcaneus.
   • Type IIC: fracture occurs on medial aspect of calcaneus.
3. Type III fractures consist of two intrarticular fractures that divide the calcaneus into 3 articular pieces.
   • Type IIIAB: two fracture lines are present, one lateral and one central.
   • Type IIIAC: two fracture lines are present, one lateral and one medial.
   • Type IIIBC: two fracture lines are present, one central and one medial.
4. Type IV fractures consist of fractures with more than three intrarticular fractures.

Extrarticular fractures include all fractures that do not involve the posterior facet of the subtalar joint.

• Type A involve the anterior calcaneus
• Type B involve the middle calcaneus. This includes the sustentaculum tali, trochlear process and lateral process.
• Type C involve the posterior calcaneus, the posterior tuberosity and medial tubercle included.