Calcaneus Fractures

Question 1

What are the two main fragments of calcaneus fractures?

Answer 1

Fracture moves from plantar medial to dorsal lateral, producing two main fragments: the sustentacular (anteromedial) and tuberosity (posterolateral) fragments.

Question 2

How often do open injuries and compartment syndrome occur with calcaneus fractures?

Answer 2

Open: 10-15%

Compartment syndrome: 10%

Question 3

What are two radiographic measures of the calcaneus?

Answer 3

Bohler’s angle: anterior process to posterior facet, posterior facet to calcaneal tuberosity (normal is 20-40°)
Gissane’s angle: angle of the posterior facet (normal 105-135°)

Question 4

What is the classification of calcaneus fractures?

Answer 4

Essex-Lopresti:

1) Tounge type
2) Joint depression

Sanders:
Based on CT scans that use 3 fracture lines to divide into 4 fragments (lateral, middle, medial, sustentaculum tali)
I- Nondisplaced
II- 2 part fractures of the posterior facet
III- 3 part fractures with central depression
IV- 4 part articular, comminuted

Question 5

What is indicated in a patient with suspected stress fracture of the calcaneus?

Answer 5

MRI

Cast immobilization for 6 weeks

Question 6

What factors are a/w poor outcomes in calcaneal fractures?

Answer 6

1) age > 50
2) obesity
3) manual labor
4) workers comp
5) smokers
6) bilateral calcaneal fractures
7) multiple trauma
8) vasculopathies
9) men do worse with surgery than women

Question 7

In ORIF of calcaneal fractures, what factors are a/w increased risk of secondary subtalar fusion?

Answer 7

male worker’s compensation patient who participates in heavy labor work with an initial Böhler angle less than 0 degrees

Question 8

What factors increase the risk of wound complications in calcaneal fractures?

Answer 8

1) Smokers
2) diabetics
3) Open injuries

Question 9

During ORIF of calcaneal fractures, what structure is at risk with placement of lateral to medial screws, especially at level of sustentaculum tali?

Answer 9

FHL;

the great toe will be in a fixed, flexed position from the tendon being tethered over a screw.

Question 10

Non-operative treatment of displaced intra-articular calcaneal fractures require late subtalar fusion for post-traumatic arthritis in what percentage of patients?

Answer 10

16%

Question 11

What factors are a/w better outcomes with ORIF vs non-operative treatment for intra-articular calcaneal fractures?

Answer 11

1) Women
2) Not worker’s comp
3) Age