According to the evidence from a recently published retrospective review and fracture severity analysis, a positive association was found between fracture energy and the Sanders classification for dislodged intra-articular calcaneal fractures (DIACFs), which can be employed to detect more severe fractures at higher risk for growing to post-traumatic osteoarthritis (PTOA).

A total of 36 participants with 48 DIACFs, ≥ 18 years old, with good quality post-op and follow up radiographs, electronic pre-op and post-op CT scans, and a follow up ≥ 18 months were chosen from previously treated 153 patients. Treatment of these fractures was done with percutaneous reduction with multiple small stab incisions and fluoroscopy to oversee manipulation of articular fragments ( with corkscrews or Steinmann pins) with subsequent fixation using 3.5- and 4.0 mm screws. Pre-op CT scans rank the fractures as per the Sanders classification and quantify the severity of the fractures. Further, a CT-based measure of fracture energy performed to quantify the fracture severity objectively. Assessment of PTOA on follow up radiographs was done using the Kellgren-Lawrence scale. Pain and functional outcomes were evaluated using the visual analogue scale pain score and the Short Form 36 (SF-36).

The 48 DIACFs ranked from 14.1 to 26.2 J and associated with Sanders classification; type I; type II; type III; type IV. Fractures with subtalar joint produced PTOA exhibited higher fracture energy as compared to those that did not; however, the difference did not attain statistical significance. PTOA risk is prophesied using the Sanders classification. VAS pain and fracture energy presented no associations, whereas lower SF-36 scores showed an association with higher fracture energy. Positive association of Sanders classification for DIACFs with fracture energy can be utilised to discover more severe fractures at higher risk for growing to PTOA.