Fractures of the sustentaculum tali: injury characteristics and surgical technique for reduction.


Journal Article

BACKGROUND: The sustentaculum tali of the calcaneus is a vital load-bearing structure. Isolated sustentacular fractures are rare and may have implications for future hindfoot function. This retrospective cohort study describes sustentacular fracture patterns and characteristics, associated foot injuries, and a method of surgical treatment via a medial approach to the calcaneus. MATERIALS AND METHODS: During a 7-year period, 19 surgically-treated sustentacular fractures without calcaneal posterior facet involvement were identified from a prospectively-collected database at a single Level 1 regional trauma center. Of these, 15 underwent open reduction and internal fixation utilizing a medial approach to the calcaneus. Patient charts, plain radiographs, and CT scans were reviewed for injury characteristics/morphology and associated musculoskeletal injuries. RESULTS: Fourteen patients had associated ipsilateral foot/ankle injuries, and nine had other musculoskeletal injuries. Seven patients had intra-articular middle facet involvement, and seven had subtalar joint subluxation or dislocation. The medial approach to the calcaneus involves distal retraction of the neurovascular bundle and toe flexors. This allowed for an accurate indirect articular reduction using the extraarticular medial calcaneal cortex, as well as reduction of any associated subluxations. No complications were related to the surgical approach. Reduction was maintained through fracture healing. CONCLUSION: Fractures of the sustentaculum tali are rare injuries associated with high energy mechanisms, and associated ipsilateral foot injuries are common. Open reduction and internal fixation of these fractures was reliable and possible through a medial approach involving distal retraction of the digital flexors and neurovascular bundle, allowing for an anatomical extraarticular cortical reduction.

Full Text

Cited Authors

  • Della Rocca, GJ; Nork, SE; Barei, DP; Taitsman, LA; Benirschke, SK

Published Date

  • November 2009

Published In

Volume / Issue

  • 30 / 11

Start / End Page

  • 1037 - 1041

PubMed ID

  • 19912711

Pubmed Central ID

  • 19912711

Electronic International Standard Serial Number (EISSN)

  • 1944-7876

International Standard Serial Number (ISSN)

  • 1071-1007

Digital Object Identifier (DOI)

  • 10.3113/fai.2009.1037


  • eng