The Sanders arrangement is employed to assess intraarticular calcaneal fractures, which are those involving the posterior facet of the calcaneus. This classification is predicated on the number of intraarticular fracture lines and their location on semicoronal CT images. This classification is beneficial not only in understanding typical fracture patterns of the calcaneus but also in predicting the result. As you progress from type 1 to type 4 injuries, expected outcomes are progressively worse.
- Type 1: includes all intraarticular fractures that have but 2 mm of articular displacement, no matter the amount of fracture lines/fragments present
- Type 2a: involves one primary fracture line that courses through the lateral aspect of the posterior facet; the first fracture usually assumes a “y” shaped configuration because it exits medially and laterally out of the calcaneal body; this fracture is usually amid one or more accessory fracture lines that don’t involve the posterior articular facet
- Type 2b: involves one primary fracture line that courses through the central aspect of the posterior facet; the first fracture usually assumes a “y” shaped configuration because it exits medially and laterally out of the calcaneal body; this fracture is usually amid one or more accessory fracture lines that don’t involve the posterior articular facet
- Type 2c: involves one primary fracture line that courses through the medial aspect of the posterior facet and is amid a transverse fracture through the body of the calcaneus; this fracture is usually amid one or more accessory fracture lines that don’t involve the posterior articular facet
- Type 3ab: involves two primary fracture lines, one coursing through the lateral aspect of the posterior facet and therefore the second through the central aspect; this subtype usually presents with depression of the central fragment; the 2 primary fracture lines could also be amid additional accessory fracture lines that don’t involve the posterior articular facet
- Type 3ac: involves two primary fracture lines, one coursing through the lateral aspect of the posterior facet and therefore the second through the medial aspect; this subtype usually presents with depression of the central fragment. the 2 primary fracture lines could also be amid additional accessory fracture lines that don’t involve the posterior articular facet
- Type 3bc: involves two primary fracture lines, one coursing through the central aspect of the posterior facet and therefore the second through the medial aspect; this subtype usually presents with depression of the central fragment; the 2 primary fracture lines could also be amid additional accessory fracture lines that don’t involve the posterior articular facet
- Type 4: involves three or more primary fracture lines with greater than 2 mm of articular displacement, and are therefore severely comminuted.
Sanders classification
based on the number of articular fragments seen on the coronal CT image at the widest point of the posterior facet
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