Maire-Clare Killen and Rajiv Limaye describe the technique and report outcomes of a series of patients undergoing minimally invasive fixation for displaced intra-articular fractures using the Wave plating system
The calcaneus is the most commonly fractured tarsal bone, with intra-articular fractures accounting for up to 75 per cent of all calcaneal injuries; these fractures in particular are associated with a high rate of morbidity and overall poor outcome [1–4].
There are numerous classification systems used to describe fractures of the calcaneus, with Sanders’ classification being one of the most commonly utilised [5]. This system is based on the number of articular fragments on a Coronal CT scan. Type I fractures are un-displaced; type II involve two articular fragments; type III involve three articular fragments; and type IV fractures have more than three articular fragments. These can be further sub-divided into types A, B and C depending on the location of the fracture lines in the posterior facet (Figure 1).
Figure 1: Diagrammatic representation of intra-articular fractures according to the Sanders classification
Treatment of calcaneal fractures as a whole remains controversial, with no clear consensus on whether operative fixation is superior to conservative management alone. There is some evidence to suggest that displaced intra-articular fractures have improved outcomes if they undergo anatomic reduction and fixation in order to restore the calcaneal shape and subtalar joint, leading to better functional scores and lower rates of secondary subtalar arthritis [6].
Fractures deemed significant enough to warrant surgical intervention were traditionally treated with fixation via an open, extensile approach to the calcaneus. Although such an approach provides good ex