A 45-year-old man has a calcaneal fracture after a fall from height. Sanders CT classification shows 4 fracture fragments in the posterior facet. What is the Sanders classification and recommended treatment?

• A Sanders Type IV — 4 or more fragments; primary subtalar fusion or ORIF acceptable; primary fusion often preferred for comminution ✓
• B Sanders Type II — 2 fragments; conservative management in a cast
• C Sanders Type III — 3 fragments; open reduction and internal fixation is preferred
• D Sanders Type I — non-displaced; operative fixation for all athletic patients

Explanation

Sanders CT classification is based on the number of fracture lines in the posterior facet of the calcaneum on the semicoronal CT cut at the widest point. Type I: non-displaced (<2mm); Type II: two fragments (one fracture line); Type III: three fragments (two fracture lines); Type IV: four or more fragments (comminuted). Sanders Type IV represents severely comminuted posterior facet fractures; ORIF becomes technically challenging with poor cartilage viability, and primary subtalar arthrodesis is often preferred, especially in older or lower-demand patients, to avoid future painful subtalar arthrosis.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.