OrthoFracs Logo

Calcaneal Fractures

Classification

Essex Lopresti

  • Extra-articular
          • Anterior process fracture
          • Superior tuberosity avulsion
          • Medial process
          • Sustentaculum tali
          • Body
  • Intra-articular*
          • Joint depression 82%
          • Tongue 18%
  • *Based on appearance of secondary fracture line on lateral XR
  • Primary Fracture Line
      • Starts at lateral wall near tarsal sinus
      • Passes in coronal plane
      • Passes obliquely across posterior facet
      • Exits at medial wall posterior to sustentaculum tali
      • Produces 2 main fragments
  • Tuberosity & Lateral wall with variable posterior facet
          • Usually comminuted
          • Usually displaces superior & lateral
  • Sustentaculum with anterior & middle facet
          • Usually undisplaced
  • Secondary Fracture Lines
      • May be numerous
      • May be divided into two types
      • Tongue & Depressed Joint types based on secondary fracture lines
      • Tongue type
          • Secondary fracture line extends posteriorly from superior point of primary line
          • Produces posterior / superior lateral fragment
          • Contains part of posterior facet & dorsal cortex of tuberosity
          • Can seesaw down anteriorly
      • Joint depression type
          • Secondary fracture line also extends posteriorly but deviates dorsally to exit posterior to posterior facet
          • Creates thalamic portion containing posterior facet
          • Thalamic fragment contains the major portion of the calcaneal surface

Eastwood

  • Coronal CT Classification
  • To aid reduction of 3 part fractures (96%, only 4% two-part fractures with only primary fracture line)
      • Not prognostic
      • Uses coronal cut at level lateral malleolus
  • 3 main fragments with inverted "Y" fracture
      • Lateral joint fragment – usually depressed, rotates into valgus
      • Sustentacular fragment – rarely depressed due to soft tissues, rotates into varus
      • Body fragment – non-articular, migrates proximally into defect

Classification based on appearance of lateral wall

  • Type 1: lateral wall formed by lateral joint fragment (37%)
  • Type 2: lateral wall fragment formed by lateral joint fragment superiorly & body fragment inferiorly (45%)
  • Type 3: lateral wall formed by body fragment (18%)