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Calcaneus Fractures

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Foot and Ankle Disorders

Abstract

Displaced fractures of the calcaneus are frequent and challenging injuries of the foot. The variable, sometimes complex, fracture patterns and the unique but vulnerable soft tissue cover of the heel require a precise analysis of the fracture pattern, soft tissue status, and overall medical condition of the patient. Treatment must be tailored individually because no single method is suitable for all fractures.

Surgery is recommended for grossly displaced extra-articular fractures and intra-articular fractures with joint incongruity of 2 mm or more. Anatomic reconstruction of the joint surfaces and realignment of the height, length, and axis of the calcaneus with meticulous soft tissue handling are important prerequisites for favorable outcomes.

Over the recent years, percutaneous and less invasive techniques have been instrumental in lowering rates of wound complications and infection. When anatomic reduction is achieved, this also translates into better outcomes. Therefore, minimally invasive treatment should not be pursued under all circumstances and a less than anatomic reduction should never be accepted. Open reduction and lateral plate fixation via an extensile lateral approach remains an established treatment for complex fracture patterns with predictable results provided meticulous soft-tissue handling. Primary subtalar fusion is a viable treatment alternative in cases of primary destruction of the subtalar joint surface.

Complications include wound healing problems, soft tissue and bone infections, soft tissue impingement and neuritis, arthrofibrosis, and painful posttraumatic arthritis of the subtalar joint. Inadequate reduction or fixation including nonoperative treatment of displaced calcaneal fractures regularly results in painful, disabling malunions that require corrective surgery.

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  1. University Center for Orthopaedics, Trauma and Plastic Surgery, University Hospital Carl Gustav Carus at TU Dresden, Dresden, Germany

    Stefan Rammelt & Christine Marx

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  1. Stefan Rammelt
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  1. Orthopedic Surgery Department, Clínica Alemana de Santiago - Universidad del Desarrollo, Santiago, RM - Santiago, Chile

    Emilio Wagner Hitschfeld

  2. Orthopedic Surgery Department, Clínica Alemana de Santiago - Universidad del Desarrollo, Hospital Militar de Santiago – Universidad de los Andes, Santiago, RM - Santiago, Chile

    Pablo Wagner Hitschfeld

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Rammelt, S., Marx, C. (2022). Calcaneus Fractures. In: Wagner Hitschfeld, E., Wagner Hitschfeld, P. (eds) Foot and Ankle Disorders. Springer, Cham. https://doi.org/10.1007/978-3-030-95738-4_54

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