A 40-year-old man falls from a height and sustains a calcaneal fracture. CT scan shows a Sanders type IIC fracture (single fracture line in the middle third of the posterior facet involving both medial and middle columns). What is the PREFERRED treatment?

• A Immediate ORIF within 8 hours to restore articular congruity
• B Non-operative management with Böhler angle restoration via Essex-Lopresti technique
• C Primary subtalar arthrodesis for all Sanders type II fractures
• D Open reduction and internal fixation (ORIF) via extensile lateral approach once soft-tissue swelling subsides ✓

Explanation

Sanders type II calcaneal fractures (single articular line dividing the posterior facet into two fragments) with displacement benefit from ORIF to restore articular congruity and Böhler angle, reducing the risk of post-traumatic subtalar arthritis. Surgery is delayed 7–14 days until soft-tissue wrinkle sign returns, as immediate surgery risks wound dehiscence due to compartment swelling. The Essex-Lopresti technique (percutaneous reduction) is used for tongue-type fractures. Primary arthrodesis is reserved for Sanders type IV (highly comminuted) fractures in older patients.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.