Calcaneal Fractures

Anatomy

Superior surface is divided into 3 articular facets:

• Posterior - largest and convex on shape
• Middle - on the sustentaculum tali, concave in shape
• Anterior - often confluent with the middle facet, concave

Between the middle and the posterior facets lies the interosseous sulcus (calcaneal groove) The anterior surface is saddle shaped, articulating with the cuboid bone

Principle functions of the calcaneum

• To act as a lever arm for the gastrosoleus complex
• To provide a foundation or vertical support for body weight
• To provide support for and to maintain the lateral column of the foot

Any fracture that impairs one of these functions will significantly affect the patients gait if not corrected or restored.

Associated injuries

Bilateral calcaneal fractures occur in 5 - 9% of patients Compression fractures of the lumbar/dorsal spine occur in 10% patients with calcaneal fractures Other injuries of the lower extremity occur in 26%, e.g. ankle, tibial fractures Soft tissue injuries Laterally the peroneal tendons can be subluxated or dislocated from the fibular sulcus Medially the fracture fragments can injure or entrap the neurovascular bundle. Flexor hallucis longus can interpose in fractures of the sustentaculum tali, trapping the tendon. Compartment syndrome develops in 10% of calcaneal fractures, with half of these develop clawing of the lesser toes or other chronic problems such as stiffness and neurovascular dysfunction. Fasciotomy should be carried out when pressure of >40mmHg are encountered.