Fractures of the anterior process of the calcaneum; a review and proposed treatment algorithm.

BACKGROUND: There remains a lack of recognition of these fractures, which leads to a delay in diagnosis and appropriate management.

METHODS: A comprehensive literature search was performed. Following inclusion and exclusion criteria, 23 studies were available for analysis.

RESULTS: Delay in diagnosis is common and has a negative impact on outcome. If an APC fracture is suspected; anteroposterior, lateral and oblique plain radiographs should be requested. Further investigation with computed tomography or magnetic resonance imaging is indicated if plain radiographs are inconclusive and patient remains symptomatic. Non-operative measures are usually adequate for most undisplaced fractures, however surgical intervention maybe required for large, intra-articular fractures in the acute setting and for non-union.

CONCLUSIONS: A treatment algorithm is suggested that may help with the diagnosis and management of these injuries.

LEVEL OF EVIDENCE: Level IV.