Paul Tornetta III, MD: We know decision making with respect to calcaneal fracture management can be difficult. Can classification help? Classification is only valuable if it is prognostic and if it assists decision making. Otherwise, it is useless. Expert

Richard E. Buckley, MD. Excellent presentation on methods of treatment of calcaneal fractures. For educational purposes may be copied, adapted and presented with acknowledgements to Dr Buckley and OTA Highly Reputable

Bruce J. Sangeorzan, MD, is associate professor of orthopaedic surgery, University of Washington, Harborview Medical Center. The literature is full of suggestions for the treatment of calcaneus fractures. Yet it is possible to read hundreds of papers devoted to calcaneus fractures and still not know which to treat or how to treat them. Closed treatment with early motion is a moderately successful treatment that remains the standard to which new treatments must be compared. However, failure to seek alternatives to closed treatment would have us accept impairments beyond a standard that would be acceptable in other intra-articular weight-bearing joints. As in most orthopaedic conditions, no valid prospective randomized trial has been completed. In the absence of such a trial, we base treatment decisions on training, experience, retrospective studies and, most worrisome, the vagaries of third-party dictum.

Wheeless' Textbook of Orthopaedics
Discussion:
- typically results from fall from height (see mechanism)
- 2 types of frx may occur: extr-articular and intra-articular:

Radiology Teaching Files. contributed by U Chicago radiolgists and residents

Calcaneal Fractures “Lover’s Fractures”
Calcaneous is the most commonly fractured tarsal bone A so-called “lover’s Fracture” is an intra-articular fracture produced by an axial loading force typically produced by a leap from a height with person landing on heels (also called a “Don Juan” fracture)
Why is it called a “Lover’s fracture?”
Because it is the type of fracture that could presumably be caused by a lover jumping out of the bedroom window to escape from a surprised and enraged spouse

Lecture Notes from Dr Buckley's presentation "The Calcaneal Fracture" (qv)

Radiology Teaching Files. Contributed by Fritsch & Thompson

Epidemiology - Most commonly fractured tarsal bone
Mechanism: Compression fracture most common
A Trauma due to fall from high height
B Forced foot dorsiflexion may also cause fracture
Associated Injuries
A Lumbar fracture (10% of calcaneus fracture)
B Other external injury (26% of calcaneus fractures)

Author: Scott Nicklebur, MD, Staff Physician, Department of Emergency Medicine, St. David's Georgetown Hospital
Contents - Introduction; Indications; Relevant Anatomy And Contraindications; Workup; Treatment; Complications; Outcome And Prognosis; Future And Controversies; Pictures; Bibliography

Authors Khan et al. 2006
Contents - Introduction Radiograph CT Scan MRI Ultrasound Nuclear Medicine Intervention Pictures Bibliography
Synonyms and related keywords: calcaneum fracture, calcaneus fracture, calcaneal fractures, tarsal fracture, os-calcis fracture, os calcis fracture, Lover fracture Lover's fracture, intra-articular calcaneal fractures, extra-articular calcaneal fractures

Discussion:
- demonstrates intra-articular extension of frx
- degree of comminution of posterior facet;
- calcaneocuboid joint;
- impingement of lateral border of calcaneus on lateral malleolus and entrapment of tendons or nerves can be demonstrated; - latter is best seen with the soft-tissue window examination;

Medscape "Ask the Experts" Posted 2001
Question What are the possible etiologies of a stress fracture of the heel in a non-athletically competitive 50-year-old woman who has a negative DEXA scan for osteoporosis? Her bone scan was positive, the x-ray was negative. What is the best next step: CT or MRI?

Medscape General Medicine 1(3), 1999. Stephen K. Benirschke, MD, and Patricia A. Kramer, PhD, Department of Orthopaedics, Harborview Medical Center, University of Washington
Abstract; Calcaneal fractures remain among the most challenging fractures encountered by orthopaedic traumatologists, but the technology exists today to treat any isolated calcaneal fracture. Critical to patient outcome is the restoration of the morphologic structure of the entire calcaneus, including the relationship between the articular surfaces and the overall length, width, and height. Open reduction and internal fixation via the extensile lateral approach is the preferred treatment for displaced calcaneal injuries, because it allows superior access to the anterior process, posterior facet, and tuberosity. Despite recent claims to the contrary, excellent results can be obtained with minimal risk to the patient. Key words: calcaneus, open reduction, internal fixation

Synopsis of Cochrane Review article on this subject.
Conclusions - Even where there is some evidence of benefit of operative compared with non – operative treatment, it remains unclear whether the possible advantages of surgery are worth its risks. Given this it seems best to wait for the results of one large ongoing trial on open reduction and internal fixation against conservative treatment.
One very small trial suggests that impulse compression therapy for intra – articular calcaneal fractures may be beneficial.