Calcaneal Fractures Flashcards
what radiographic angles do you look for on x-ray if you suspect calcaneal fracture?
Bohler’s angle
critical angle of Gissane
when position does the heel assume after a fall from height?
varus position; heel will often drop in height and get wider too
what is Bohler’s angle?
angle formed by the line drawn from the postero-superior surface of the calcaneus and another line drawn thru the anterior process
what is the normal range for Bohler’s angle?
25-40 deg
what angle will increase in a calcaneal fracture?
critical angle of Gissane
what angle will decrease in a calcaneal fracture? why?
Bohler’s angle - in a calcaneal fx, the posterior facet is driven into the calcaneus, making the angle smaller
what is the normal range for critical angle of Gissane?
120-145 deg
what is the critical angle of gissane?
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
which calcaneal classification systems are based on CT scans?
Sanders and Hannover classifications
which vertebrae is most commonly fractured after a fall from height?
L1
don’t forget to get lumbar spine films in your trauma patient!!
what physical exam findings will you see in a patient with suspected calcaneal fracture?
- pain with medial to lateral compression
- edema
- Mondor’s sign
- inability to bear weight
what is the name of the clinical sign for ecchymosis medial and plantar on the foot?
Mondor’s sign
what extra-articular classification system is used for calcaneal fractures?
Rowe
Classify this: avulsion fracture of the tuberosity
Rowe 2b
Classify this: body fracture involving the STJ (intra-articular)
Rowe 4
Classify this: fracture of the calcaneal tubercle
Rowe 1a
Classify this: body fracture not involving the STJ (extra-articular)
Rowe 3
Classify this: fracture of sustentaculum tali
Rowe 1b
Classify this: beak fx of the tuberosity
Rowe 2a
Classify this: fracture of the anterior process of calcaneus
Rowe 1c
Classify this: joint depression with comminution (intra-articular)
Rowe 5
What is the mechanism of injury of a Rowe 1a?
fall w/ heel inverted or everted –>leads to fx of med/lat tubercle
What is the MOI of a Rowe 1b?
fall with twisting on a supinated foot –> fx of sustentaculum tali
what structure will be very tender in a Rowe 1b fracture?
FHL
What is the MOI of Rowe 1c?
supination and plantarflexion –> fx of anterior process
what is the most common type of Rowe 1 fracture?
Rowe 1c
what is the mechanism of injury for a Rowe 2a fracture?
direct trauma –> beak fx ( a fracture of the superior portion of tuberosity) but spares achilles tendon insertion
what is the MOI of a Rowe 2b fx?
strong pull of achilles tendon –> avulsion fx of tuberosity
a Rowe 2b fx may lead to what etiology of hammertoes?
flexor substitution (due to deep posterior group overcompensating for gastroc + soleus due to achilles tendon avulsion)
what is the MOI for a Rowe 3?
fall from height w/ heel in varus or valgus –> fx of body without STJ involvement
what is the MOI for a Rowe 4?
fall from height with foot plantarflexed –> intra-articular fx of the body
what is the MOI for a Rowe 5?
fall form height with foot dorsiflexed –> intra-articular fx with joint depression and comminution
which rowe classification system is the same as Essex-lopresti tongue type fracture?
Rowe 4
which rowe classifications sytem is teh same as Essex-lopresti joint depression fx?
Rowe 5
What is the Essex-Lopresti tongue type fx?
primary fx line (shear fx) which is intra-articular and separates the sustentaculum tali from the lateral body; secondary fx thru teh tuberosity
what is the Essex-Lopresti depression type fx?
shear fx that divdies teh calcaneus into 2 parts: sustentaculum tali and tuberosity fragment;
lateral wall blowout
how does the sanders classfication divdide calcaneus fractures?
divided into 4 parts (lateral, central, medial, sustentaculum tali) by fx lines
lines A, B, and C are organized how?
lateral to medial
Classify this: all nondisplaced intra-articualr fx
Sanders type 1
in general,what is sanders type 2?
two part fractures of the posterior facet
Classify this: 2 part fracture; primary fx line separates the lateral column from the central.
sanders 2a
Classify this: 2 part fracture; primary fx line is central and separates the central column from the medial.
sanders 2b
Classify this: 2 part fracture; primary fx line is medial and separates the medial column from the sustentaculum tali.
sanders 2c
Classify this: 3 part fracture; two fracture lines separate the posterior facet into lateral, central, and mEdial columns.
sanders 3ab
classify this: 3 part fx; two fracture lines separate the posterior facet into lateral column, central/medial and sustentaculum column.
sanders 3ac
classify this: 3 part fx; two fracture lines separate the posterior facet into lateral/central column, medial column, and sustentaculum column.
sanders 3bc
classify this: 4 part fx with 3 fx lines and is highly comminuted with joint depression
sanders 4
