Current concepts in the management of calcaneal fractures

Abstract

Introduction. Despite advances in non-operative and surgical management, calcaneal fractures remain severe injuries with relatively poor clinical outcomes. These fractures predominantly affect young, active individuals and are often associated with long-term sequelae, permanent disability, a considerable reduction in quality of life, and a substantial economic impact due to work incapacity and rehabilitation needs. Material and methods. This study is a narrative literature review. A bibliographic search was conducted using PubMed, Hinari, SpringerLink, National Center for Biotechnology Information, and Medline databases. Articles published from 1990 to 2024 were selected based on keyword combinations such as “calcaneal fracture,” “comminuted calcaneal fracture,” “orthopedic treatment”, “surgical treatment,” “minimally invasive treatment,” “osteosynthesis,” “locking plate,” and “locked intramedullary nail.” After processing information from these databases according to the search criteria, 225 full-text articles were identified. The final bibliography includes 56 relevant sources, which were considered representative of the materials published on the topic of this synthesis article. Results. Surgical treatment using open reduction and internal fixation for displaced intra-articular calcaneal fractures was superior to non-surgical treatment in restoring Bohler’s angle, achieving more stable calcaneal height and width, improving functional recovery, reducing the number of patients requiring orthopedic footwear, and enabling return to pre-injury activities, though it carries a high risk of complications. The minimally invasive approach via the sinus tarsi and the extended lateral L-shaped approach are equally effective for treating Sanders type II and III fractures in terms of restoring anatomical structures, radiological outcomes, and functional recovery. However, the sinus tarsi approach is effective in reducing wound complication rates (3.6–6.3% vs. 13.5–31.2%, respectively; p < 0.05), pain syndrome rates, time to surgery (p < 0.0001), surgery duration (p < 0.05), and hospital stay duration. Therefore, the minimal incision approach is a good alternative to the extended lateral L-shaped approach. Conclusions. The current concept in managing calcaneal fractures involves developing an individualized treatment plan based on the patient’s characteristics and functional requirements, comorbidities, fracture type, and associated injuries, as well as the surgeon’s experience with the selected surgical technique.