Calcaneus Fractures

Calcaneus fractures represent the most frequent of tarsal bone fractures and the 2% of all fractures. The cause is an axial impact on one or both heels. They can be divided into extra- and intra-articular fractures. Fractures involving any of the three subtalar joint surfaces are known as intra-articular; they account for 75% of all calcaneal fractures and can be classified based on computed axial tomography (CT) with the Sanders classification to define treatment. Clinical diagnosis is straightforward since considerable edema is observed erasing the wrinkles of the heel and the edges of the Achilles tendon and occasionally those of the malleoli. It is accompanied by plantar and lateral infra malleolar ecchymosis, and after a few hours of evolution, blisters may appear. It is important to evaluate the soft tissues before the surgery, since the wrinkle sign is used to decide the best time to perform the surgery. The traditional approach to perform reduction and fixation (osteosynthesis) of calcaneal fractures is the extended lateral approach. Sinus tarsi approach (STA) is associated with a lower complication rate and quicker operation duration. The most common sequelae is post-traumatic osteoarthritis of the subtalar joint. Also, skin necrosis and injury to the sural nerve are part of the most relevant complications of this pathology.