FRACTURES OF THE CALCANEUS: ETIOLOGY, PATHOPHYSIOLOGY, EPIDEMIOLOGY, CLASSIFICATION AND DIAGNOSIS

Abstract

Objectives. To review current concepts regarding etiology, pathophysiology, epidemiology, classification, and diagnosis of patients with intraarticular calcaneal fractures.

Methods.  Literary sources from PubMed, Hinari, SpringerLink, National Center of Biotechnology Information, and Medline databases were studied regarding etiology, pathophysiology, epidemiology, classification, and diagnosis of calcaneal fractures, using the keywords: "intraarticular calcaneal fractures", "etiology", "pathophysiology", "epidemiology", "classification", and "diagnosis", with 25 relevant bibliographic sources selected representative for the materials published on the topic of this review article.

Results. Calcaneal fractures constitute approximately 1-2% of the total number of fractures and approximately 60% of tarsal fractures in adults. About 60-75% of calcaneal fractures are intraarticular involving the posterior facet of the calcaneus, 5-10% of cases are bilateral, and less than 10% are open. The main causes that determine calcaneal fractures are: falls from height and landing on heels with axial loading of the bone (60%), road traffic accidents, stress fractures in athletes, direct trauma at the calcaneal level. Most frequently (80-90%), calcaneal fractures occur in men aged between 20 and 45 years, with predilection (70%) in industrial workers during work. In women, the maximum incidence of these fractures is observed at the age of 60-70 years. Although there are several classifications of calcaneal fractures based on different criteria (Bohler, 1931; Crosby and Fitzgibbons, 1990; Eastwood, 1993; Zwipp, 1993), the most frequently used classification systems are Sanders (1993) based on coronal computed tomography imaging and Essex-Lopresti (1952) based on lateral radiography.

Conclusions. The diagnosis of calcaneal fracture is based on medical history, clinical examination, and imaging investigations. Medical history reveals the mechanism of fracture production, debut symptomatology, and associated conditions. Clinical examination highlights fracture signs and fracture type. Ankle and foot radiography in anteroposterior, lateral, oblique, Harris-type, and Broden-type views reveals fracture lines, calcaneal deformation, and severity of adjacent lesions. Computed tomography provides detailed images of the lesion, better visualization and characterization of the subtalar joint, fracture lines and displaced fragments, obtaining classification criteria for severity, subsequent evaluation, and treatment planning.