Calcaneal Fracture Flashcards
What is the most commonly fractured tarsal bone?
Calcaneum
Mechanism of injury
Fall from height whereby there is significant axial loading directly onto the bone.
Associated injuries of calcaneal fracture
Concurrent fractures (particularly spinal or contralateral calcaneus)
Severe visceral injuries
Around 15% of all calcaneal are open fractures
Due to the mechanism of injury.
Classification
Divided into intra-articular and extra-articular fractures.
Intra-articular = 75%
Extra-articular = 25%
Explain intra-articular calcaneal fractures
Involves the articular surface of the subtalar joint and can be further classified by the Sanders classification
Explain extra-articular calcaneal fractures
Commonly avulsion fractures with sparing of the articular surface of the subtalar joint.
This includes avulsion of the calcaneal tuberosity by the achilles tendon.
Explain Sanders classification
Management is guided by Sanders classification.
Intra-articular fractures will likely require definitive fixation.
Type I - Nondisplaced posterior facet (regardless of number of fracture lines)
Type II - One fracture line in the posterior facet (two fragments)
Type III - Two fracture lines in the posterior facet (three fragments)
Type IV - Comminuted with more than three fracture lines in the posterior facet (four or more fragments)
Clinical features
Recen trauma such as fall from a heigh or RTC
Pain and tenderness around the calcaneal region with an inability to weight bear.
Examination findings
Swollen and bruised heel
Potentially shortened and widened heel.
Varus deformity
Assess for posterior heel skin integrity.
Any tenting or blanched skin will warrant emergency surgical intervention.
Dx
Talar fracture
Ankle fracture
Soft tissue injury
Ix
Should be investigated and managed according to ATLS protocol.
Urgent bloods + coag and G&S
Plain X-ray using AP, lateral and oblique views.
CT is gold standard for assessing calcaneal fractures and should be performed in any suspected case
X-ray findings
Calcaneal shortening
Varus tuberosity deformity
Decreased Böhler’s angle
Explain Böhler’s angle
The posterior angle formed between one line from the anterior to middle facet and one line from the posterior to middle facet.
Normally 20-40 degrees
Reduced Böhler’s angle can indicate calcaneal fracture
Indications of conservative management
Intraarticular that is < 2mm displacement or near normal Böhler’s angle
Extraarticular fractures may be treated conservatively.
Most intra-articular will be surgically
Explain conservative management
Cast immobilisation and non-weight bearing for 10-12 weeks
Indications for surgical management.
All intra-articular fractures unless they are mild.
Extra-articular fractures that have significant displacement.
Explain surgical interventions
Closed reduction with percutaneous pinning
ORIF
Emergency surgical fixation
When is closed reduction with percutaneous pinning indicated.
It can be attempted for large (>1cm) but minimally diplaced fractures
Usually ORIF is indicated as the surgery method of choice.
Which fractures warrants ORIF?
Open fractures
Posterior facet displacement
Reduced Böhler’s angle
Calcaneocuboid joint involvement
Complications
Subtalar arthritis
Analgesia
Physiotherapy
