In two typical cases of calcaneal fracture dislocation, the primary fracture, which runs forward and medially from a point behind the sustentaculum tali, is associated with inversion of the hindfoot. The calcaneus splits into a small anteromedial and a larger posterolateral fragment. Rupture of the lateral collateral ligament allows the posterolateral calcaneal fragment to move laterally to lie immediately subjacent to the distal fibula. Closed reduction is impossible. Open reduction of this rare fracture dislocation is essential. A lateral approach to the calcaneus is generally sufficient, but a second medial incision may be required.
Senior Lecturer, Department of Orthopaedic Surgery, University of Edinburgh, Princess Margaret Rose Orthopaedic Hospital, Edinburgh, United Kingdom.
Clinical Lecturer, University Department of Orthopaedic Surgery, Royal Liverpool Hospital, Liverpool, United Kingdom.
Staff Surgeon, Sunnybrook Medical Centre, Toronto, Canada.