Calcaneum Fractures: Sanders Classification, Bohler's Angle & Rehab

Fractures of the Calcaneum

The calcaneus (heel bone) is the most commonly fractured tarsal bone. It is usually caused by a fall from height ("Lover's Fracture") and is often associated with lumbar spine fractures.

1. Classification

• Extra-articular (25%): Beak fractures, tuberosity avulsions.
• Intra-articular (75%): Involves the subtalar joint.
  • Sanders Classification: Based on CT scan coronal cuts (Number of fragments).

2. Radiological Angles

Bohler's Angle: Normal = 20-40°. In depression fractures, it decreases (< 20°).
Gissane's Angle: Normal = 95-105°. Increases in fracture.

3. Management

• Conservative: For non-displaced or elderly/diabetic patients. Non-weight bearing for 8-12 weeks.
• Surgical: ORIF (Plate) or Percutaneous Screws. Goal: Restore Bohler's angle and joint surface.

4. Complications

• Subtalar Arthritis: Common late complication (pain on uneven ground).
• Widened Heel: Causes difficulty fitting shoes.
• Wound Dehiscence: High risk with lateral incision.

20 Practice MCQs

Q1. Most calcaneal fractures are caused by:

Answer: A). Heel hits the ground first.

Q2. "Lover's Fracture" refers to:

Answer: A). Historically named "Don Juan fracture".

Q3. Normal Bohler's Angle is:

Answer: A). Decreases with collapse.

Q4. Associated injury commonly seen with calcaneus fracture:

Answer: A). Force transmits up the skeleton.

Q5. Sanders Classification is based on:

Answer: A). Determines prognosis and treatment.

Q6. Most common long-term complication is:

Answer: A). Due to cartilage damage.

Q7. Mondor's Sign in calcaneus fracture is:

Answer: A). Pathognomonic sign.

Q8. Intra-articular fractures involve which joint?

Answer: A). Posterior facet is usually depressed.

Q9. Essex-Lopresti maneuver is for:

Answer: A). Using a spike to lever the fragment up.

Q10. Why is wound healing a major concern in surgery?

Answer: A). Wait for "Wrinkle Sign" before surgery.

Q11. Sustentaculum Tali is usually:

Answer: A). Used as an anchor for reduction.

Q12. Widening of the heel causes:

Answer: A). Lateral wall blowout.

Q13. Harris Axial View X-ray shows:

Answer: A). Skyline view of the heel.

Q14. Avulsion of the Achilles insertion causes:

Answer: A). Skin necrosis is a risk if not treated.

Q15. Subtalar fusion is indicated for:

Answer: A). Late salvage procedure.

Q16. Smoking increases risk of:

Answer: A). Surgery often avoided in heavy smokers.

Q17. Heel pad pain is caused by:

Answer: A). Chronic pain source.

Q18. Angle of Gissane normal value is:

Answer: A). Increases in fracture.

Q19. Compartment syndrome of the foot:

Answer: A). Requires fasciotomy.

Q20. Which tendon can get trapped or impinged?

Answer: A). Due to lateral wall blowout.