Fracture mapping of complex intra-articular calcaneal fractures

BACKGROUND: Intra-articular calcaneal fracture remains challenging to manage. Computed tomography and fracture mapping are useful for the diagnosis and treatment of calcaneal fractures. The aim of the present study was to characterize calcaneal fracture patterns using fracture mapping. METHODS: Sixty-two calcaneal fractures were retrospectively included in the study. For each case, the fracture was simulated reduction manually. The fracture lines and zones of comminution were graphically superimposed onto an intact calcaneal template to identify fracture patterns. Major fracture lines and comminution were assessed by focusing on the posterior joint facet, medial wall, lateral wall, sustentaculum tali, and anterior process. RESULTS: The fracture lines were mostly concentrated on the area anterior to the posterior joint facet and extended medially. The longitudinal lines ran posteriorly from the angle of Gissane, and separated the sustentaculum tali and medial wall from the calcaneal tuberosity. In the lateral wall, the fracture lines extended posteriorly with some branches to the bottom of the calcaneus. No fracture lines passed through the sustentaculum tali. Fracture lines of the posterior tuberosity and anterior process were rare. CONCLUSIONS: Calcaneal fracture lines follow characteristic patterns, which are closely related to the bone structure and fracture mechanism. These fracture patterns will aid clinicians choose surgical approach and fixations in the treatment of calcaneal fractures.