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EM/Trauma Exam 2 > Calcaneal Fractures > Flashcards

Calcaneal Fractures Flashcards

1
Q

what radiographic angles do you look for on x-ray if you suspect calcaneal fracture?

A

Bohler’s angle

critical angle of Gissane

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2
Q

when position does the heel assume after a fall from height?

A

varus position; heel will often drop in height and get wider too

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3
Q

what is Bohler’s angle?

A

angle formed by the line drawn from the postero-superior surface of the calcaneus and another line drawn thru the anterior process

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4
Q

what is the normal range for Bohler’s angle?

A

25-40 deg

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5
Q

what angle will increase in a calcaneal fracture?

A

critical angle of Gissane

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6
Q

what angle will decrease in a calcaneal fracture? why?

A

Bohler’s angle - in a calcaneal fx, the posterior facet is driven into the calcaneus, making the angle smaller

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7
Q

what is the normal range for critical angle of Gissane?

A

120-145 deg

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8
Q

what is the critical angle of gissane?

A

angle between a line drawn thru the posterior and middle facet of calcaneus and another lawn drawn thru the middle and anterior facet of calcaneus

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9
Q

which calcaneal classification systems are based on CT scans?

A

Sanders and Hannover classifications

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10
Q

which vertebrae is most commonly fractured after a fall from height?

A

L1

don’t forget to get lumbar spine films in your trauma patient!!

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11
Q

what physical exam findings will you see in a patient with suspected calcaneal fracture?

A
  • pain with medial to lateral compression
  • edema
  • Mondor’s sign
  • inability to bear weight
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12
Q

what is the name of the clinical sign for ecchymosis medial and plantar on the foot?

A

Mondor’s sign

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13
Q

what extra-articular classification system is used for calcaneal fractures?

A

Rowe

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14
Q

Classify this: avulsion fracture of the tuberosity

A

Rowe 2b

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15
Q

Classify this: body fracture involving the STJ (intra-articular)

A

Rowe 4

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16
Q

Classify this: fracture of the calcaneal tubercle

A

Rowe 1a

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17
Q

Classify this: body fracture not involving the STJ (extra-articular)

A

Rowe 3

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18
Q

Classify this: fracture of sustentaculum tali

A

Rowe 1b

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19
Q

Classify this: beak fx of the tuberosity

A

Rowe 2a

20
Q

Classify this: fracture of the anterior process of calcaneus

A

Rowe 1c

21
Q

Classify this: joint depression with comminution (intra-articular)

A

Rowe 5

22
Q

What is the mechanism of injury of a Rowe 1a?

A

fall w/ heel inverted or everted –>leads to fx of med/lat tubercle

23
Q

What is the MOI of a Rowe 1b?

A

fall with twisting on a supinated foot –> fx of sustentaculum tali

24
Q

what structure will be very tender in a Rowe 1b fracture?

A

FHL

25
Q

What is the MOI of Rowe 1c?

A

supination and plantarflexion –> fx of anterior process

26
Q

what is the most common type of Rowe 1 fracture?

A

Rowe 1c

27
Q

what is the mechanism of injury for a Rowe 2a fracture?

A

direct trauma –> beak fx ( a fracture of the superior portion of tuberosity) but spares achilles tendon insertion

28
Q

what is the MOI of a Rowe 2b fx?

A

strong pull of achilles tendon –> avulsion fx of tuberosity

29
Q

a Rowe 2b fx may lead to what etiology of hammertoes?

A

flexor substitution (due to deep posterior group overcompensating for gastroc + soleus due to achilles tendon avulsion)

30
Q

what is the MOI for a Rowe 3?

A

fall from height w/ heel in varus or valgus –> fx of body without STJ involvement

31
Q

what is the MOI for a Rowe 4?

A

fall from height with foot plantarflexed –> intra-articular fx of the body

32
Q

what is the MOI for a Rowe 5?

A

fall form height with foot dorsiflexed –> intra-articular fx with joint depression and comminution

33
Q

which rowe classification system is the same as Essex-lopresti tongue type fracture?

A

Rowe 4

34
Q

which rowe classifications sytem is teh same as Essex-lopresti joint depression fx?

A

Rowe 5

35
Q

What is the Essex-Lopresti tongue type fx?

A

primary fx line (shear fx) which is intra-articular and separates the sustentaculum tali from the lateral body; secondary fx thru teh tuberosity

36
Q

what is the Essex-Lopresti depression type fx?

A

shear fx that divdies teh calcaneus into 2 parts: sustentaculum tali and tuberosity fragment;
lateral wall blowout

37
Q

how does the sanders classfication divdide calcaneus fractures?

A

divided into 4 parts (lateral, central, medial, sustentaculum tali) by fx lines

38
Q

lines A, B, and C are organized how?

A

lateral to medial

39
Q

Classify this: all nondisplaced intra-articualr fx

A

Sanders type 1

40
Q

in general,what is sanders type 2?

A

two part fractures of the posterior facet

41
Q

Classify this: 2 part fracture; primary fx line separates the lateral column from the central.

A

sanders 2a

42
Q

Classify this: 2 part fracture; primary fx line is central and separates the central column from the medial.

A

sanders 2b

43
Q

Classify this: 2 part fracture; primary fx line is medial and separates the medial column from the sustentaculum tali.

A

sanders 2c

44
Q

Classify this: 3 part fracture; two fracture lines separate the posterior facet into lateral, central, and mEdial columns.

A

sanders 3ab

45
Q

classify this: 3 part fx; two fracture lines separate the posterior facet into lateral column, central/medial and sustentaculum column.

A

sanders 3ac

46
Q

classify this: 3 part fx; two fracture lines separate the posterior facet into lateral/central column, medial column, and sustentaculum column.

A

sanders 3bc

47
Q

classify this: 4 part fx with 3 fx lines and is highly comminuted with joint depression

A

sanders 4

EM/Trauma Exam 2 (2 decks)

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