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    RSNA Education Exhibits

    Fractures of the Calcaneus: A Review with Emphasis on CT

    Published Online:Sep 1 2005https://doi.org/10.1148/rg.255045713

    Abstract

    The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures. Advances in cross-sectional imaging, particularly in computed tomography (CT), have given this modality an important role in identifying and characterizing calcaneal fractures. Fracture characterization is essential to guide the management of these injuries. Calcaneal fractures have characteristic appearances based on the mechanism of injury and are divided into two major groups, intraarticular and extraarticular. Most calcaneal fractures (70%–75%) are intraarticular and result from axial loading that produces shear and compression fracture lines. Of the two major systems for classifying intraarticular fractures–Hannover and Sanders–the latter is used most often and is helpful in treatment planning and determining prognosis. Extraarticular fractures account for about 25%–30% of calcaneal fractures and include all fractures that do not involve the posterior facet. The article describes in detail calcaneal anatomy, mechanism of calcaneal injuries and their associated fracture patterns, CT features of intra- and extraarticular fractures, and management implications. Familiarity with calcaneal anatomy and fracture patterns is essential for radiologists to guide the treating physicians.

    © RSNA, 2005

    References

    • 1 HartyM. Anatomic considerations in injuries of the calcaneus. Orthop Clin North Am1973; 4: 179–183. Crossref, Medline, Google Scholar
    • 2 FitzgibbonsT, McMullen ST, Mormino MA. Fractures and dislocations of the calcaneus. In: Bucholz RW, Heckman JD, eds. Rockwood and Green’s fractures in adults. Philadelphia, Pa: Lippincott Williams & Wilkins, 2001; 2133–2179. Google Scholar
    • 3 GrayH. Anatomy of the human body. Philadelphia, Pa: Lea & Febiger, 1918; Bartelby.com; 2000. Google Scholar
    • 4 CarrJB. Mechanism and pathoanatomy of the intraarticular calcaneal fracture. Clin Orthop Relat Res1993; 290: 36–40. Medline, Google Scholar
    • 5 BurdeauxBD. Reduction of calcaneal fractures by the McReynolds medial approach technique and its experimental basis. Clin Orthop Relat Res1983; 177: 87–103. Medline, Google Scholar
    • 6 BuckwalterKA, Rydberg J, Kopecky KK, Crow K, Yang EL. Musculoskeletal imaging with multi-slice CT. AJR Am J Roentgenol2001; 176: 979–986. Crossref, Medline, Google Scholar
    • 7 LinsenmaierU, Brunner U, Schoning A, et al. Classification of calcaneal fractures by spiral computed tomography: implications for surgical treatment. Eur Radiol2003; 13: 2315–2322. Crossref, Medline, Google Scholar
    • 8 CarrJB, Hamilton JJ, Bear LS. Experimental intra-articular calcaneal fractures: anatomic basis for a new classification. Foot Ankle1989; 10: 81–87. Crossref, Medline, Google Scholar
    • 9 EastwoodDM, Phipp L. Intra-articular fractures of the calcaneus: why such controversy? Injury1997; 28: 247–259. Crossref, Medline, Google Scholar
    • 10 Essex-LoprestiP. The mechanism, reduction technique, and results in fractures of the os calcis. Br J Surg1952; 39: 395–419. Crossref, Medline, Google Scholar
    • 11 MyersonM, Manoli A. Compartment syndromes of the foot after calcaneal fractures. Clin Orthop Relat Res1993; 290: 142–150. Medline, Google Scholar
    • 12 PaleyD, Hall H. Calcaneal fracture controversies: can we put Humpty Dumpty together again? Orthop Clin North Am1989; 20: 665–677. Medline, Google Scholar
    • 13 SandersR, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures: results using a prognostic computed tomography scan classification. Clin Orthop Relat Res1993; 290: 87–95. Medline, Google Scholar
    • 14 CrosbyLA, Fitzgibbons T. Computerized tomography scanning of acute intra-articular fractures of the calcaneus: a new classification system. J Bone Joint Surg Am1990; 72: 852–859. Crossref, Medline, Google Scholar
    • 15 SandersR, Gregory P. Operative treatment of intra-articular fractures of the calcaneus. Orthop Clin North Am1995; 26: 203–214. Crossref, Medline, Google Scholar
    • 16 SandersR. Intra-articular fractures of the calcaneus: present state of the art. J Orthop Trauma1992; 6: 252–265. Crossref, Medline, Google Scholar
    • 17 ZwippH, Tscherne H, Thermann H, Weber T. Osteosynthesis of displaced intraarticular fractures of the calcaneus: results in 123 cases. Clin Orthop Relat Res1993; 290: 76–86. Medline, Google Scholar
    • 18 FureyA, Stone C, Squire D, Harnett J. Os calcis fractures: analysis of interobserver variability in using Sanders classification. J Foot Ankle Surg2003; 42: 21–23. Crossref, Medline, Google Scholar
    • 19 TrnkaHJ, Zettl R, Ritschl P. Fracture of the anterior superior process of the calcaneus: an often misdiagnosed fracture. Arch Orthop Trauma Surg1998; 117: 300–302. Crossref, Medline, Google Scholar
    • 20 KatholMH, el-Khoury GY, Moore TE, Marsh JL. Calcaneal insufficiency avulsion fractures in patients with diabetes mellitus. Radiology1991; 180: 725–729. Link, Google Scholar
    • 21 SquiresB, Allen PE, Livingstone J, Atkins RM. Fractures of the tuberosity of the calcaneus. J Bone Joint Surg Br2001; 83: 55–61. Crossref, Medline, Google Scholar

    Article History

    Published in print: Sept 2005