- See:
-
Calcaneal Frx in Children:
-
Fatigue Fractures of the Calcaneus
-
Fractures of the Anterior Process:
-
Sub-Talar Joint
-
Sustentaculuum Tali Fractures:
- Discussion:
- typically results from fall from height (see
mechanism)
- 2 types of frx may occur:
extr-articular and
intra-articular:
-
intra-articular frx: includes a
primary frx line and often a
secondary frx line;
-
primary frx line:
- most of these involve the
posterior facet (but can involve
anterior and
middle facets);
-
sustentacular fragment (constant fragment)
- anteromedial (sustentacular) frag is rarely comminuted but varies in size;
- it remains attached to the talus by strong
deltoid ligament and by the interosseous
ligament lies in the interosseous sulcus between the posterior and middle facets;
-
tuberosity fragment (posterolateral fragment)
- displaces superiorly & laterally resulting in incongruity of
posterior facet and widening & shortening of heel;
- further axial loading may fracture tuberosity fragment creating a supero-lateral fragment of posterior facet;
-
thalamic fragment: depressed portion of the posterior facet;
-
misc characteristics:
- anteriorly frx may exit laterally, usually at angle of Gissane, but it can also involve the calcaneocuboid joint;
- heel becomes shortened and widened;
- tuberosity fragment tilts into varus and is pulled proximally by the Achilles tendon;
- displaced supero-lateral fragment can impinge upon peroneal tendons;
- lateral wall becomes comminuted;
- frx extends thru
posterior facet which becomes incongruous;
- talus become dorsiflexed;
-
fracture classification:
-
Sander's Classification:
- Rowe: types 1-5 (types 4-5 intra-articular)
- Essex Lopresti:
-
extra-articular:
- intra-artiulcar:
-
tounge fracture:
-
joint depression calcaneal fracture:
-
associated injuries:
- frx of contra-lateral foot;
-
spinal compression frx;
- soft tissue injury:
-
compartment syndrome deep central compartment is involved most often in calcaneal frx;
-
frx blisters:
- references:
-
The management of soft-tissue problems associated with calcaneal fractures.
-
Compartment syndrome of the foot after intraarticular calcaneal fracture.
-
Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome.
-
Open calcaneal fractures: results of operative treatment.
-
Wound healing complications in closed and open calcaneal fractures.
- Radiographic Evaluation:
- Treatment Options:
-
Non operative treatment:
- contraindications to open reduction:
- smoking patient who is unwilling to immediately quit smoking;
- vasculopath:
- with advanced age, diabetes, or questionable vascular exam, order non invasive vascular studies;
-
ORIF using lateral approach:
- in the review by TV Tufescu and R Buckley, the authors conducted a prospective cohort study of 169 patients that
sustained intra-articular calcaneal fractures;
- they found that operatively treated fractures returned to work quicker (av 87 days sooner);
- in patients that performed heavy work:
- non op patients returned to work at 273 days vs ORIF patients who returned at av 171 days;
- ref: Age, Gender, Work Capability, and Worker's Compensation in Patients with Displaced Intra-articular Calcaneal Fractures.
TV Tufescu and R. Buckley. JOT. Vol 15. No 4. p 275.
-
Primary Subtalar Fusion for Calcaneal Fracture
-
Percutaneous Fixation:
- may be indicated for patients with inadequate soft tissues (diabetics with frx blisters) where risk of dehissence is high;
- main goal is to regain calcaneal height and width and to take the calcaneus out of varus alignment;
- no attempt is made to reconstruction the articular surface;
- technique:
- manual position across the calcaneal body;
- large threaded Steinman pin is placed through the posterior superior portion of the calcaneal tuberosity;
- longitudinal traction is applied across the Steinman pin w/ a valgus vector applied as well;
- threaded Steinman pin is inserted through the posterior inferior corner of the calcaneus, across posterior facet and into the talar body;
- this stabilizes the valgus reduction;
- threaded Steinman pin is inserted through the posterior calcaneus into the cuboid;
- in study by Bruce Ziran and P. Bosch, of 25 frxs, 12 patients reported little or no pain, 7 patients had moderate pain, and 2 patients had severe pain;
- ref: Closed reduction and percutaneous pinning for comminuted intra-articular fractures of the calcaneus: Preliminary results.
Bruce Ziran and P. Bosch. 15th Annual Meeting of the Orthopaedic Trauma Association, 1999.
-
Complications of Treatment:
- Calcaneal Frx in Children:
Current Concepts Review. Intra-Articular Fractures of the Calcaneus.
The medial approach for calcaneal fractures.
Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors.
Intra-articular fractures of the calcaneum. Part I: Pathological anatomy and classification.
Mechanism and pathoanatomy of the intraarticular calcaneal fracture.
Anatomy of the calcaneus.
Fractures of the calcaneum: the anterolateral fragment.
Computed tomographic assessment of soft tissue abnormalities following calcaneal fractures.
Magnetic resonance imaging evaluation of calcaneal fat pads in patients with os calcis fractures.
Intra-articular fractures of the calcaneus: Present state of the art.
R. Sanders. J. Orthop. Trauma. Vol 6. 1992. p 252-265.
Intra-articular fractures of the calcaneus.
AA. Giachino and HK Uhthoff. JBJS Vol 71-A. 1989. p 784-786.
Fractures of the calcaneus: open reduction and internal fixation from the medial side a 21-year prospective study.
Operative Compared with Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures. A Prospective, Randomized, Controlled Multicenter Trial
Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome.
