Calcaneal Fractures-Which Approach for Which Fracture?

Fractures of the calcaneus require an individualized treatment approach and precise preoperative planning. Nondisplaced and mildly displaced extraarticular fractures, intraarticular fractures with step-offs of less than 2 mm, and patients with general contraindications to surgery are best treated nonoperatively. Open fractures and closed fractures with compartment syndrome or severe soft tissue incarceration resulting from internal fragment pressure are treated as emergencies. Severely displaced extraarticular and less severe intraarticular fractures may be treated with percutaneous reduction and fixation. The latter is also a useful temporary measure in more severe fracture patterns with severe soft tissue damage or a critical overall condition of the patient. In the absence of contraindications, most of the displaced, intraarticular fractures are best treated by open reduction and internal fixation. Selected, less invasive approaches and novel fixation techniques have the potential to minimize soft tissue complications while ensuring anatomic reduction and stable fixation. For best outcomes the procedure should be performed by an experienced surgeon. Nonoperative treatment of severely displaced fractures or failure to achieve anatomic reduction with surgical treatment regularly results in painful malunions with rapidly evolving subtalar arthritis.