What is the best management for a comminuted left calcaneal fracture with mild displacement, classified as Sanders Type 2?

From the Guidelines

Management of Comminuted Left Calcaneal Fracture

The best management for a comminuted left calcaneal fracture with mild displacement, classified as Sanders Type 2, is typically non-operative, focusing on conservative treatment, as surgery is usually reserved for more complex or displaced fractures 1.

• This approach involves immobilization in a non-weight-bearing cast or splint to allow the bone fragments to heal in place.
• Pain management is crucial and can be achieved with medications such as acetaminophen or ibuprofen for the first few weeks.
• It's essential to closely monitor the fracture for any signs of displacement or complications, with regular X-rays every 1-2 weeks for the first 6 weeks.
• In cases where the fracture is deemed unstable or shows signs of significant displacement, surgical intervention may be considered, but this is typically reserved for more severe cases, and the initial approach for a Sanders Type 2 fracture with mild displacement is conservative 1.
• The goal of conservative management is to promote healing, restore function, and minimize the risk of complications, making it the preferred initial approach for managing comminuted left calcaneal fractures with mild displacement, classified as Sanders Type 2.

From the Research

Management of Comminuted Left Calcaneal Fracture with Mild Displacement

Overview of Treatment Options

The management of comminuted left calcaneal fractures with mild displacement, classified as Sanders Type 2, can be approached through various treatment options, including conservative treatment, open reduction and internal fixation, and primary arthrodesis.

• Conservative treatment may be considered for non-displaced or minimally displaced fractures, as it may be simpler, less expensive, and easier to administer with fewer complications 2.
• Open reduction and internal fixation is currently the most commonly used surgical procedure, but it has a high incidence of postoperative incision complications 3.
• Primary arthrodesis may be considered for severely comminuted calcaneal fractures, as it provides overall good results considering the severe nature of the injury 4.

Classification and Treatment Guidance

The Sanders classification is widely used to guide the selection of treatment methods and evaluation of prognosis for calcaneal fractures 3.

• Medial column classification can effectively guide the surgical selection for intra-articular fractures of the calcaneus, with excellent and good outcomes reported in 95.6% of cases 3.
• The choice of specific treatment options is still controversial, and the optimal management of displaced intra-articular calcaneal fractures is highly debated in the literature 5.

Outcomes and Complications

The outcomes of treatment for comminuted left calcaneal fractures with mild displacement can vary depending on the treatment option chosen.

• Conservative treatment has been reported to result in a mean AOFAS score of 72, with osteoarthritis evident in 90% of cases 2.
• Open reduction and internal fixation has been reported to result in a higher rate of major complications, such as surgical site infection, compared to conservative treatment 6.
• Primary arthrodesis has been reported to result in a weighted average modified AOFAS score of 77.4, with a union rate of 97% and overall good results considering the severe nature of the injury 4.