One of the commonly occurring injury which is frustrating to treat. Intra articular fractures involve either only the subtalar joint or there may be associated injury through the calcaneo cuboid joint.

Classification

Fractures of calcaneus involving subtalar joint were classified by Essex Lopresti into two types, Joint depression type and Tongue type. A large series of operatively treated calcaneal fractures are reported from Hannover. They have devised their own system of classification. There is also a classification based on C.T. scan study for managing these complex fractures.

Special Investigations

Broden's oblique views and C.T. scan are helpful in defining the fracture patterns and deciding the approach, method of fixation and whether bone grafting is required. The aims of treatment of these complex fractures are to get a painless, supple, mobile foot, failing which to get a painless, stiff foot. Majority of the centres treat calcaneal fractures non operatively.

Non operative treatment consists of attempted reduction of the fracture, and application of plaster followed by mobilisation.

Operative treatment consists of axial pin fixation method of Essex Lopresti or open reduction by medial or lateral approach. Certain centres perform primary subtalar or triple fusion for these complex fractures.

Complications

Painful subtalar joint, impingement of peroneal tendons by the callus, painful flat foot are some of the common complications of this fracture.