Calcaneal Fracture Classification

Courtesy: Prof Nabil Ebraheim

Classification:
Extra Articular Fractures
• Anterior process fractures
• Tuberosity fractures
• Medial process fractures
• Sustentacular fractures
• Body fractures not involving the subtalar articulation

Intra Articular Fractures (Essex Lopresti Classification)

Intra- articular fractures involve the subtalar joint. They have primary and secondary fracture lines. Intra articular fractures are more common (75%)

Primary Fracture Line
Producing two main fragments:
– Sustentacular (anteromedial) and the tuberosity (posterolateral) fragments.
– The anteromedial sustentacular fragment is also called the ‘constant fragment‘ because of its resistance to significant displacements.
– The anteromedial fragment consists of part of the posterior facet, anterior process, middle and anterior facets, supported by the sustentaculum tali.
– The posterolateral fragment consists of the tuberosity and lateral wall along with a variable portion of the posterior facet.

Secondary Fracture Line
• Tongue fracture. Secondary fracture line appears beneath the facet and exits posteriorly. The relationship of the lateral posterior facet and the superior aspect of the tuberosity remain intact.

• Joint depression fracture: Secondary fracture line exits just behind the posterior facet. Joint depression fractures are those in which the secondary fracture line separates the lateral posterior facet from the body and tuberosity of the calcaneus.