Significant progress has been made in terms of the management of calcaneal
fractures. This is reflected in the marked decrease in complication rates a
ssociated with the current intervention of these potentially devastating in
juries. The treatment priorities that, in the authors opinion, are key to a
chieve best results in a displaced calcaneal fracture are anatomic reconstr
uction of the entire calcaneus: articular surfaces, height, alignment, and
length, with a function directed postoperative management. The value of the
se priorities are confirmed by the authors longterm follow-up results as pr
esented here. To reemphasize, conservative treatment should be considered o
nly in cases of extraarticular fractures, minor displaced intraarticular fr
actures in nonambulatory patients, and in cases where there is a clear cont
raindication for surgery. Regarding the technical requirements for an anato
mic reconstruction, the os calcis fracture should be categorized as a proce
dure for experts. In two-part fractures, according to the Sanders classific
ation, an anatomical reduction is obtainable in more than 80%-90% of cases.
However, in consideration of the articular cartilage damage, a 70% rate of
good to excellent clinical results seems realistic. In three-part fracture
s, anatomic reduction is attainable in about 60% of cases with a 70% rate o
f good results. These two subgroups comprise about 90% of all calcaneus fra
ctures. It is the authors recent experience to optimize the extended latera
l approach using posteromedial and anterolateral windows, so that an anatom
ic reduction in more than 60% of Sanders Type III os calcis fractures can b
e achieved. Further scientific work in this area of trauma orthopedics woul
d benefit most from a general consensus on a fracture classification system
and on a clinical scoring system, with 5 year follow-up studies using thes
e treatment methods and evaluation systems.