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Controversies in calcaneus fracture management: a systematic review of the literature

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Abstract

Despite the fact that the calcaneus is the commonest tarsal bone fractured, many controversies exist in the literature regarding the management options. This stems from the fact that the understanding of the fracture pattern has evolved only recently, surgical approaches have lately been standardized, surgical timing has become more clear, and newer implants are regularly being introduced. Despite the significant advances, complications and controversies related to this common fracture abound. The present paper looks at all aspects of modern management options of calcaneus fractures and tries to review the literature with regard to the controversial issues that still persist.

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References

  1. Pozo JL, Kirwan EO, Jackson AM (1984) The long-term results of conservative management of severely displaced fractures of the calcaneus. J Bone Joint Surg Br 66(3):386–390

    PubMed  CAS  Google Scholar 

  2. Crosby LA, Fitzgibbons T (1993) Intraarticular calcaneal fractures. Results of closed treatment. Clin Orthop 290:47–54

    PubMed  Google Scholar 

  3. Cohen M (2001) Calcaneal fractures. Foot and Ankle Surgery 2:1819–1863

    Google Scholar 

  4. Buckley R, Tough S, McCormack R (2002) Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am 84(10):1733–1744

    PubMed  Google Scholar 

  5. Böhler L (1957) Fersenbeinfrakturen. In: Böhler L (ed) Die Technik der Knochenbruchbehandlung. Wien, Maudrich, pp 2148–2217

    Google Scholar 

  6. Essex-Lopresti P (1952) The mechanism, reduction technique, and results in fractures of the os calcis. Br J Surg 39:395–419

    Article  PubMed  CAS  Google Scholar 

  7. Soeur R, Remy R (1975) Fractures of the calcaneus with displacement of the thalamic portion. J Bone Joint Surg Br 57:413–421

    PubMed  CAS  Google Scholar 

  8. Sanders R, Fortin P, DiPasquale A, Walling A (1993) Operative treatment in 120 displaced intra-articular calcaneal fractures. Results using a prognostic computed tomographic scan classification. Clin Orthop 290:87–95

    PubMed  Google Scholar 

  9. Zwipp H, Tscherne H, Wu¨lker N, Grote R (1989) Intra-articular fracture of the calcaneus. Classification Unfallchirurg 92:117–129

    CAS  Google Scholar 

  10. Lauder AJ, Inda DJ, Bott AM et al (2006) Interobserver and intraobserver reliability of two classification systems for intra-articular calcaneus fractures. Foot Ankle Int 27:251–255

    PubMed  Google Scholar 

  11. Kumar V, Hameed A, Bhattacharya R et al (2006) Role of computerized tomography in management of intraarticular fractures of the os calcis. Int Orthop 30:110–112

    Article  PubMed  CAS  Google Scholar 

  12. Cotton FJ, Henderson FF (1916) Results of fractures of the os calcis. Am J Orthop Surg 14:290

    Google Scholar 

  13. Melcher G, Degonda F, Leutenegger A, Reudi T (1995) Ten year follow up after operative treatment for intraarticular fractures of calcaneus. J Trauma 38:713–716

    Article  PubMed  CAS  Google Scholar 

  14. Jarvholm U, Komer L, Thoren O, Wiklund LM (1984) Fractures of the calcaneus. A comparison of open and closed treatment. Acta Orthop Scand 55:652–656

    Article  PubMed  CAS  Google Scholar 

  15. Buckley RE, Meek RN (1992) Comparison of open versus closed reduction of intraarticular calcaneal fractures: a matched cohort in workmen. J Orthop Trauma 6:216–222

    Article  PubMed  CAS  Google Scholar 

  16. Leung KS, Yuen KM, Chan WS (1993) Operative treatment of displaced intra-articular fractures of the calcaneus. Medium-term results. J Bone Joint Surg Br 75(2):196–201

    PubMed  CAS  Google Scholar 

  17. O’Farrell DA, O’Byme JM, McCabe JP, Stephens MM (1993) Fractures of the os calcis: improved results with internal fixation. Injury 24:263–265

    Article  PubMed  Google Scholar 

  18. Parmar HV, Triffitt PD, Gregg PJ (1993) Intra-articular fractures of the calcaneus treated operatively or conservatively. A prospective study. J Bone Joint Surg Br 75:932–937

    PubMed  CAS  Google Scholar 

  19. Thordarson DB, Krieger LE (1996) Operative vs nonoperative treatment of intraarticular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int 17:2–9

    PubMed  CAS  Google Scholar 

  20. Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, Galpin R (2002) Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am 84(10):1733–1744

    PubMed  Google Scholar 

  21. Allmacher DH, Galles KS, Marsh JL (2006) Intraarticular calcaneal fractures treated nonoperatively and followed sequentially for two decades. J Orthop Trauma 20:464–469

    Article  PubMed  Google Scholar 

  22. Ibrahim T, Rowsell M, Rennie W, Brown AR, Taylor GJ, Gregg PJ (2007) Displaced intra-articular calcaneal fractures: 15-year follow-up of a randomised controlled trial of conservative versus operative treatment. Injury 38:848–855

    Article  PubMed  CAS  Google Scholar 

  23. Randle JA, Kreder HJ, Stephen D, Williams J, Jaglal S, Hu R (2000) Should calcaneal fractures be treated surgically? A meta-analysis. Clin Orthop Relat Res 377:217–227

    Article  PubMed  Google Scholar 

  24. Melcher G, Degonda F, Leutenegger A, Rüedi T (1995) Ten-year follow-up after operative treatment for intra-articular fractures of the calcaneus. J Trauma 38(5):713–716

    Article  PubMed  CAS  Google Scholar 

  25. Potter MQ, Nunley JA (2009) Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus. J Bone Joint Surg Am 91(8):1854–1860

    Article  PubMed  Google Scholar 

  26. Rammelt S, Barthel S, Biewener A, Gavlik JM, Zuipp H (2003) Calcaneus fractures. Open reduction and internal fixation [in German]. Zbl Chir 128:517–528

    PubMed  CAS  Google Scholar 

  27. Tennent T, Calder P, Salisbury R, Allen P, Eastwood D (2001) The operative management of displaced intra-articular fractures of the calcaneus: a two-centre study using a defined protocol. Injury 32:491–496

    Article  PubMed  CAS  Google Scholar 

  28. Zgonis T, Roukis TS, Polyzois VD (2006) The use of Ilizarov technique and other types of external fixation for the treatment of intraarticular calcaneal fractures. Clin Podiatr Med Surg 34:3–53

    Google Scholar 

  29. McGarvey WC, Burris MW, Clinton TO et al (2006) Calcaneal fractures: indirect reduction and internal fixation. Foot Ankle Int 27:494–499

    PubMed  Google Scholar 

  30. Hatzokos I, Karataglis D, Papdopolis P et al (2006) Treatment of intra-articular comminuted os calcis fractures. Orthopaedics 29:25–29

    Google Scholar 

  31. Khorbi A, Chebil M, Ben Maitigue M et al (2006) Screw fixation without bone graft of calcaneal joint fractures [in French]. Rev Chir Orthop Repartrice Appar Mot 92:45–51

    Article  CAS  Google Scholar 

  32. Schepers T, Patka P (2009) Treatment of displaced intra-articular calcaneal fractures by ligamentotaxis: current concepts’ review. Arch Orthop Trauma Surg 129(12):1677–1683

    Article  PubMed  CAS  Google Scholar 

  33. Rammelt S, Gavlik JM, Barthel S (2002) The value of subtalar arthroscopy in the management of intra-articular calcaneus fractures. Foot Ankle Int 23(10):906–916

    PubMed  Google Scholar 

  34. Forgon M (1992) Closed reduction and percutaneus osteosynthesis: technique and results in 265 calcaneal fractures. In: Tscherne H, Schatzker J (eds) Major fractures of the pilon, the talus and the calcaneus. Springer, Berlin, pp 207–213

    Google Scholar 

  35. Stehlik J, Stulik J (2002) Combined method of treating dislocated fractures of the calcaneus [in Czech]. Acta Chir Orthop Traumatol Czech 69:209–218

    CAS  Google Scholar 

  36. Omoto H, Nakamura K (2001) Method for manual reduction of displaced intra-articular fracture of the calcaneus: technique, indications and limitations. Foot Ankle Int 22:874–879

    PubMed  CAS  Google Scholar 

  37. Westhues H (1935) Eine neue Behandlungsmethode der Calcaneusfrakturen. Zugleich ein Vorschlag zur Behandlung der Talusfrakturen. Zentralbl Chir 35:995–1002

    Google Scholar 

  38. Gissane W (1947) News notes: proceedings of the British orthopedic association. J Bone Joint Surg 29:254–255

    Google Scholar 

  39. Tornetta P III (1998) The Essex-Lopresti reduction for calcaneal fractures revisited. J Orthop Trauma 12:469–473

    Article  PubMed  Google Scholar 

  40. Gavlik JM, Rammelt S, Zwipp H (2002) Percutaneous, arthroscopically-assisted osteosynthesis of calcaneus fractures. Arch Orthop Trauma Surg 122:424–428

    PubMed  Google Scholar 

  41. Gavlik JM, Rammelt S, Zwipp H (2002) The use of subtalar arthroscopy in open reduction and internal fixation of intra-articular calcaneal fractures. Injury 33:63–71

    Article  PubMed  Google Scholar 

  42. Benirschke SK, Sangeorzan BJ (1993) Extensive intraarticular fractures of the foot. Surgical management of calcaneal fractures. Clin Orthop 292:128–134

    PubMed  Google Scholar 

  43. Boack DH, Wichelhaus A, Mittlmeier T, Hottmann R, Haas NP (1998) Therapy of dislocated calcaneus joint fracture with the AO calcaneus plate. Chirurg 69:1214–1223 [in German]

    Article  PubMed  CAS  Google Scholar 

  44. Letournel E (1993) Open treatment of acute calcaneal fractures. Clin Orthop 290:60–67

    PubMed  Google Scholar 

  45. Zwipp H, Tscherne H, Thermann H, Weber T (1993) Osteosynthesis of displaced intraarticular fractures of the calcaneus. Results in 123 cases. Clin Orthop 290:76–86

    PubMed  Google Scholar 

  46. McReynolds JS (1982) The surgical treatment of fractures of the os calcis. J Bone Joint Surg: Orthop Trans 6:415

    Google Scholar 

  47. Burdeaux BD (1983) Reduction of calcaneal fractures by the McReynolds medial approach technique and its experimental basis. Clin Orthop 177:87–103

    PubMed  Google Scholar 

  48. Zwipp H (1994) Chirurgie des Fußes. Springer, New York

    Book  Google Scholar 

  49. Johnson EE, Gebhardt JS (1993) Surgical management of calcaneal fractures using bilateral incisions and minimal internal fixation. Clin Orthop 290:117–124

    PubMed  Google Scholar 

  50. Stephenson JR (1987) Treatment of displaced intra-articular fractures of the calcaneus using medial and lateral approaches, internal fixation, and early motion. J Bone Joint Surg Am 69:115–130

    PubMed  CAS  Google Scholar 

  51. Tile M (1996) Fractures of the calcaneus. In: Schatzker J, Tile M (eds) The rationale of operative fracture care. Springer, Berlin, pp 589–603

    Chapter  Google Scholar 

  52. Geel CW, Flemister ASJ (2001) Standardized treatment of intraarticular calcaneal fractures using an oblique lateral incision and no bone graft. J Trauma 50:1083–1089

    Article  PubMed  CAS  Google Scholar 

  53. Laughlin RT, Carson JG, Calhoun JH (1996) Displaced intraarticular calcaneus fractures treated with the Galveston plate. Foot Ankle Int 17:71–78

    PubMed  CAS  Google Scholar 

  54. Bauer G, Kinzl L (1996) The low contact plate for stabilizing the dislocated intra-articular calcaneus fractures [in German]. Chirurg 67:1129–1134

    Article  PubMed  CAS  Google Scholar 

  55. Sanders R (2000) Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am 82:225–250

    PubMed  CAS  Google Scholar 

  56. Thordarson DB, Latteier M (2003) Open reduction and internal fixation of calcaneal fractures with a low profile titanium calcaneal perimeter plate. Foot Ankle Int 24:217–221

    PubMed  Google Scholar 

  57. Boack DH, Wichelhaus A, Mittlmeier T, Hottmann R, Haas NP (1998) Therapy of dislocated calcaneus joint fracture with the AO calcaneus plate [in German]. Chirurg 69:1214–1223

    Article  PubMed  CAS  Google Scholar 

  58. Stoffel K, Booth G, Rohri SM, Kuster M (2007) A comparison of conventional versus locking plates in intraarticular calcaneal fractures: a biomechanical study in human cadavers. Clin Biomech (Bristol, Avon) 22:100–105

    Article  Google Scholar 

  59. Redfern DJ, Oliveira ML, Campbell JT et al (2006) A biomechanical comparison of locking and nonlocking plates for the fixation of calcaneal fractures. Foot Ankle Int 27:196–201

    PubMed  Google Scholar 

  60. Richter M, Droste P, Goesling T et al (2006) Polyaxially-locked plate screws increase the stability of fracture fixation in an experimental model of calcaneal fracture. J Bone Joint Surg Br 88:1257–1263

    Article  PubMed  CAS  Google Scholar 

  61. Brattebo J, Molster AO, Wirsching J (1995) Fractures of the calcaneus: a retrospective study of 115 fractures. Orthop Int 3:117–126

    Google Scholar 

  62. Thordarson DB, Hedman TP, Yetkinler DN, Eskander E, Lawrence TN, Poser RD (1999) Superior compressive strength of a calcaneal fracture construct augmented with remodelable cancellous bone cement. J Bone Joint Surg Am 81:239–246

    PubMed  CAS  Google Scholar 

  63. Thordarson DB, Bollinger M (2005) SRS cancellous bone cement augmentation of calcaneal fracture fixation. Foot Ankle Int 26:347–352

    PubMed  Google Scholar 

  64. Schildhauer TA, Bauer TW, Josten C, Muhr G (2000) Open reduction and augmentation of internal fixation with an injectable skeletal cement for the treatment of complex calcaneal fractures. J Orthop Trauma 14:309–317

    Article  PubMed  CAS  Google Scholar 

  65. Kiyoshige Y, Takagi M, Hamasaki M (1997) Bone-cement fixation for calcaneus fracture—a report on 2 elderly patients. Acta Orthop Scand 68:408–409

    Article  PubMed  CAS  Google Scholar 

  66. Larsson S, Bauer T (2002) Use of injectable calcium phosphate cement for fracture fixation: a review. Clin Orthop Relat Res. 395:23–32

    Article  PubMed  Google Scholar 

  67. Elsner A, Jubel A, Prokop A, Koebke J, Rehm KE, Andermahr J (2005) Augmentation of intraarticular calcaneal fractures with injectable calcium phosphate cement: densimetometry, histology, and functional outcome of 18 patients. J Foot Ankle Surg 44:390–395

    Article  PubMed  Google Scholar 

  68. Huber FX, Hillmeier J, McAurthur N et al (2006) The use of nanocrystalline hydroxyapetite for the reconstruction of calcaneal fractures: preliminary results. J Foot Ankle Surg 45:322–328

    Article  PubMed  Google Scholar 

  69. Bloemers FW, Stahl JP, Sarkar MR, Linhart W, Rueckert U, Wippermann BW (2004) Bone substitution and augmentation in trauma surgery with a resorbable calcium phosphate bone cement. Eur J Trauma 30:17–22

    Article  Google Scholar 

  70. Sarkar MR, Stahl JP, Wachter N et al (2002) Defect reconstruction in articular calcaneus fractures with novel calcium phosphate cement. EurJ Trauma 28:340–348

    Article  Google Scholar 

  71. Johal HS, Buckley RE, Le IL, Leighton RK (2009) A prospective randomized controlled trial of a bioresorbable calcium phosphate paste (alpha-BSM) in treatment of displaced intra-articular calcaneal fractures. J Trauma 67(4):875–882

    Article  PubMed  CAS  Google Scholar 

  72. Jiang SD, Jiang LS, Dai LY (2008) Surgical treatment of calcaneal fractures with use of beta-tricalcium phosphate ceramic grafting. Foot Ankle Int 29(10):1015–1019

    Article  PubMed  Google Scholar 

  73. Yu S, Dong Q, Wang Y (2008) Application of allograft bone transplantation in treatment of displaced intra-articular calcaneal fractures [Article in Chinese]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 22(7):869–872

    PubMed  Google Scholar 

  74. Longino D, Buckley RE (2001) Bone graft in the operative treatment of displaced intraarticular calcaneal fractures: is it helpful. J Orthop Trauma 15:280–286

    Article  PubMed  CAS  Google Scholar 

  75. Nie WZ, Sun L, Yang MQ, Tan YC, Zhu HF (2009) Comparison between mini-traumatic bone-grafting and non-bone-grafting in percutaneous K-wire fixation to treat the calcaneal fractures][Article in Chinese]. Zhongguo Gu Shang 22(1):1–3

    PubMed  Google Scholar 

  76. Wiley JJ, Profitt A (1984) Fractures of the os calcis in children. Clin Orthop 188:131–138

    PubMed  Google Scholar 

  77. Mora S, Thordarson DB, Zionts LE et al (2001) Pediatric calcaneal fractures. Foot Ankle Int 22(6):471–477

    PubMed  CAS  Google Scholar 

  78. Schantz K, Rasmussen F (1988) Good prognosis after calcaneal fracture in childhood. Acta Orthop Scand 59(5):560–563

    Article  PubMed  CAS  Google Scholar 

  79. Brunet JA (2000) Calcaneal fractures in children. Long-term results of treatment. J Bone Joint Surg Br 82(2):211–216

    Article  PubMed  CAS  Google Scholar 

  80. Ceccarelli F, Faldini C, Piras F, Giannini S (2000) Surgical versus non-surgical treatment of calcaneal fractures in children: a long-term results comparative study. Foot Ankle Int 21(10):825–832

    PubMed  CAS  Google Scholar 

  81. Buckingham R, Jackson M, Atkins R (2003) Calcaneal fractures in adolescents. CT classification and results of operative treatment. Injury 34(6):454–459

    Article  PubMed  Google Scholar 

  82. Pickle A, Benaroch TE, Guy P et al (2004) Clinical outcome of pediatric calcaneal fractures treated with open reduction and internal fixation. J Pediatr Orthop 24(2):178–180

    Article  PubMed  Google Scholar 

  83. Petit CJ, Lee BM, Kasser JR, Kocher MS (2007) Operative treatment of intraarticular calcaneal fractures in the pediatric population. J Pediatr Orthop 27(8):856–862

    Article  PubMed  Google Scholar 

  84. Paley D, Hall H (1993) Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors. J Bone Joint Surg Am 75:342–354

    PubMed  CAS  Google Scholar 

  85. Lindsay WR, Dewar FP (1958) Fractures of the os calcis. Am J Surg 95:555–576

    Article  PubMed  CAS  Google Scholar 

  86. Herscovici D Jr, Widmaier J, Scaduto JM, Sanders RW, Walling A (2005) Operative treatment of calcaneal fractures in elderly patients. J Bone Joint Surg Am 87(6):1260–1264

    Article  PubMed  Google Scholar 

  87. Basile A (2010) Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures in elderly patients. J Foot Ankle Surg 49(1):25–32

    Article  PubMed  Google Scholar 

  88. Myerson MS (1995) Primary subtalar arthrodesis for the treatment of comminuted fractures of the calcaneus. Orthop Clin North Am 26:215–227

    PubMed  CAS  Google Scholar 

  89. Myerson M, Quill GE Jr (1993) Late complications of fractures of the calcaneus. J Bone Joint Surg Am 75:331–341

    PubMed  CAS  Google Scholar 

  90. Paley D, Hall H (1989) Calcaneal fracture controversies. Can we put Humpty Dumpty together again? Orthop Clin North Am 20:665–677

    PubMed  CAS  Google Scholar 

  91. Romash MM (1988) Calcaneal fractures: three-dimensional treatment. Foot Ankle 8:180–197

    PubMed  CAS  Google Scholar 

  92. Wilson PD (1927) Treatment of fractures of the os calcis by arthrodesis of the subtalar joint. JAMA 89:676–679

    Article  Google Scholar 

  93. Gallie WE (1943) Subastragalar arthrodesis in fractures of the os calcis. J Bone Joint Surg 25:732–736

    Google Scholar 

  94. Dick IL (1953) Primary fusion of the posterior subtalar joint in the treatment of fractures of the calcaneus. J Bone Joint Surg Br 35-B:375–380

    PubMed  CAS  Google Scholar 

  95. Buch BD, Myerson MS, Miller SD (1996) Primary subtalar arthrodesis for the treatment of comminuted calcaneal fractures. Foot Ankle Int 172:61–70

    Google Scholar 

  96. Huefner T, Thermann H, Geerling J et al (2001) Primary subtalar arthrodesis of calcaneal fractures. Foot Ankle Int 22:9–14

    PubMed  CAS  Google Scholar 

  97. Huefner T, Geerling J, Gerich T et al (2007) Open reduction and internal fixation by primary subtalar arthrodesis for intra-articular calcaneal fractures. Oper Orthop Traumatol 19:155–169

    Article  Google Scholar 

  98. Potenza V, Caterini R, Farsetti P, Bisicchia S, Ippolito E (2010) Primary subtalar arthrodesis for the treatment of comminuted intra-articular calcaneal fractures. Injury 41(7):796–800

    Article  Google Scholar 

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No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. The authors have no conflicts in interest while working on this project.

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Dhillon, M.S., Bali, K. & Prabhakar, S. Controversies in calcaneus fracture management: a systematic review of the literature. Musculoskelet Surg 95, 171–181 (2011). https://doi.org/10.1007/s12306-011-0114-y

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