Computerized tomography scanning of acute intra-articular fractures of the calcaneus. A new classification system.

Abstract

Computerized tomography was used to evaluate thirty intra-articular fractures of the calcaneus in twenty-seven patients. A classification of the fractures was devised on the basis of fracture patterns involving the posterior facet joint of the calcaneus. In Type I, the fracture fragments were small or not displaced; in Type II, they were displaced; and in Type III, they were comminuted. There were thirteen Type-I, ten Type-II, and seven Type-III fractures, all of which were treated with a variety of closed methods. The length of follow-up ranged from eighteen to fifty-two months (mean, thirty-six months). The results were graded by a predetermined point system that included the evaluation of motion of the subtalar joint. Of the thirteen Type-I fractures, eight had an excellent result; four, a good result; and one, a fair result. Of the ten Type-II fractures, two had a good result; four, a fair result; and four, a poor result. All of the seven Type-III fractures had a poor result. On the basis of our study of the fracture patterns as seen on the computerized tomography scans, we believe that it is possible to predict which fractures will do well with closed treatment and which will not. Type-I fractures did well with closed treatment. Type-II fractures can be treated closed but with a lower success rate than Type-I fractures. All of the Type-III fractures had a poor result after closed treatment.