Fractures of the calcaneum: the anterolateral fragment

Abstract

Our previous reports on the pathological anatomy and operative treatment of intra-articular fractures of the calcaneum failed to take account of the fracture pattern anterior to the posterior facet of the subtalar joint. We have reviewed our experience of 63 operative cases and have studied fractures with axial and coronal CT scans reconstructed onto plastic model bones. A constant anterolateral fragment exists, which is displaced by an extended lateral approach to the fracture. If it is unrecognised and unreduced, union in a displaced position may limit hindfoot eversion and disrupt the calcaneocuboid joint. We describe techniques for reduction and fixation of the fragment.

Displaced intra-articular fractures of the calcaneum: what is new?

“…Several papers by two sets of investigators (Eastwood et al, 1993;Tscherne and Zwipp, 1993) describe three major fragments relating to the body of the bone and the posterior facet. A further two fragments involving the anterior part of the bone may affect the calcaneocuboid joints and the anterior=middle facets of the subtalar joints (Tscherne and Zwipp, 1993;Langdon et al, 1994). This identi®cation of ®ve fragments, two major joints and one minor joint forms the basis of the Hannover classi®cation system (Tscherne and Zwipp, 1993) ( Figure 5).…”

Crush Fractures of the Anterior end of Calcaneum

“…The most frequent mechanism of fracture involving a part of the anterior end calcaneum is an inversion injury, with the foot in plantar flexion, leading to an avulsion of the bifurcate ligament. 3 4 8 10 This may occur when participants are wearing high heels, which may explain the higher incidence of this injury in females. 2 5 These patients may also have a calcaneonavicular coalition, long anterior calcaneal process, thickened anterior talofibular ligament, or thickened bifurcate ligament.…”

“…Nevertheless delayed detection of these fractures increases likelihood of painful nonunion and chronic pain, often with limitations of eversion of the foot. 8 13 15 …”

Demographic features of intra-articular fractures of the calcaneum

“…Coronal CT scans were classified using the methods described by Sanders [10], Crosby and Fitzgibbon’s [12] and Atkins [13]. Axial CT scans were classified by the method described by Zwipp and Tscherne [11] and Atkins [16, 17].…”