A 55-year-old man falls from height and sustains a calcaneal fracture with intra-articular extension. CT scan demonstrates a Sander's Type IV fracture (comminuted, involving all three columns of the posterior facet). The Böhler's tuber-joint angle on lateral radiograph is 5°. For a medically fit, non-diabetic, non-smoking patient, the most appropriate management is:
- A Primary subtalar arthrodesis ✓
- B Conservative management with early range of motion
- C Open reduction and internal fixation via extensile lateral approach
- D Percutaneous screw fixation under fluoroscopy
Explanation
Sander's Type IV calcaneal fractures represent severely comminuted articular destruction of the posterior facet with 4+ articular fragments. Primary subtalar arthrodesis (fusion) is the preferred treatment for this pattern in suitable patients because the articular fragments cannot be meaningfully reconstructed to restore subtalar joint congruity, and secondary subtalar arthritis requiring fusion later is near-universal. ORIF is appropriate for Types II–III, where anatomical reconstruction of the posterior facet is feasible. Böhler's angle restoration is a key radiological goal; angles < 10° indicate severe displacement.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.