Injuries associated with calcaneal fractures—An MRI assessment

Twenty one consecutive isolated calcaneal fractures (mean age 46; range 19–75) were treated by open reduction and internal fixation. In 19 patients, MRI scans were undertaken at (mean) 7.5 weeks to assess the technical aspects of reduction and fixation, and identify associated soft tissue and tarsal injuries. Clinical outcome was assessed with a validated scoring system, and compared with the demonstrable injuries.Assessment of the intra-articular fracture reduction and screw position was obscured in a proportion of cases and for this reason MRI is not the technique of choice for to assessing the post-operative reduction.However, MRI did reveal pathology which other imaging could not assess including abscess formation, non-viable bone, osteochondritis and plantar muscle changes. The lateral wall fragment of the calcaneum was found to be viable in all uncomplicated cases.This study also documented signal changes in the talus in 11 cases (58%) consistent with persisting bone marrow oedema, and in 5 cases (26%) persisting subcutaneous oedema of the heel pad was demonstrated. These findings may indicate a cause for the patients’ symptoms in the recovery period; however, they did not correlate with clinical outcome scores at 2 years, and we consider that these lesions are likely to resolve completely.