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Calcaneal Fracture Classifications - Everything You Need To Know - Dr. Nabil Ebraheim
Calcaneal Fracture Classifications - Everything You Need To Know - Dr. Nabil Ebraheim
Published: 2012/06/14
Channel: nabil ebraheim
Calcaneal Fracture ORIF with Arthrex Calcaneal Fracture Plate™ Utilizing Quickset™
Calcaneal Fracture ORIF with Arthrex Calcaneal Fracture Plate™ Utilizing Quickset™
Published: 2016/07/06
Channel: What's New in Orthopaedics
Calcaneal fractures - Operative techniques (OTA lecture series IV L15c)
Calcaneal fractures - Operative techniques (OTA lecture series IV L15c)
Published: 2016/05/14
Channel: OrthoClips
Calcaneal fractures - Anatomy, evaluation, classification (OTA lecture series IV L15a)
Calcaneal fractures - Anatomy, evaluation, classification (OTA lecture series IV L15a)
Published: 2016/05/14
Channel: OrthoClips
Open Reduction and Internal Fixation of Calcaneal Fractures
Open Reduction and Internal Fixation of Calcaneal Fractures
Published: 2014/10/02
Channel: ORTHOinfo
calcaneal fracture closed reduction Surgery.wmv
calcaneal fracture closed reduction Surgery.wmv
Published: 2010/08/08
Channel: Dr. Vikram
Open Reduction and Internal Fixation of Comminuted Fractures of the Calcaneus
Open Reduction and Internal Fixation of Comminuted Fractures of the Calcaneus
Published: 2016/11/25
Channel: ortho tube
Types of Calcaneus Fracture or Broken Heel
Types of Calcaneus Fracture or Broken Heel
Published: 2016/07/28
Channel: Epainassist.com
Broken calcaneus IT
Broken calcaneus IT'S OK! 😊
Published: 2017/05/05
Channel: Jaime Totten
Calcaneus Fracture Physical Therapy (Nov 17, 2011)
Calcaneus Fracture Physical Therapy (Nov 17, 2011)
Published: 2011/11/18
Channel: firefighterretired
Calcaneal Fractures  Evaluation and Surgical Treatment
Calcaneal Fractures Evaluation and Surgical Treatment
Published: 2016/06/08
Channel: Shirish Karki
Calcaneal Fracture Perimeter Plate
Calcaneal Fracture Perimeter Plate
Published: 2015/02/19
Channel: What's New in Orthopaedics
Surgical Treatment for Calcaneus Fracture or Broken Heel, Its Types
Surgical Treatment for Calcaneus Fracture or Broken Heel, Its Types
Published: 2014/08/01
Channel: Epainassist.com
Calcaneal Fractures
Calcaneal Fractures
Published: 2014/08/10
Channel: Anna Pickens
Calcaneal Fracture Open Reduction Internal Fixation
Calcaneal Fracture Open Reduction Internal Fixation
Published: 2016/10/01
Channel: Ortho Desk
Broken heel/calcaneus fracture! My story..
Broken heel/calcaneus fracture! My story..
Published: 2017/01/25
Channel: Aaron Guy
Calcaneus Fracture Minimal Invasive Approach [MIS]
Calcaneus Fracture Minimal Invasive Approach [MIS]
Published: 2014/07/11
Channel: Ashish Shah MD foot & Ankle Orthopedics
Calcaneal IntraArticular Fractures Essex Lopresti - Everything You Need To Know - Dr. Nabil Ebraheim
Calcaneal IntraArticular Fractures Essex Lopresti - Everything You Need To Know - Dr. Nabil Ebraheim
Published: 2012/10/19
Channel: nabil ebraheim
Calcaneal Intra-Articular Fractures, Sanders - Everything You Need To Know - Dr. Nabil Ebraheim
Calcaneal Intra-Articular Fractures, Sanders - Everything You Need To Know - Dr. Nabil Ebraheim
Published: 2012/10/22
Channel: nabil ebraheim
Fractures of the Calcaneus Heel Bone
Fractures of the Calcaneus Heel Bone
Published: 2015/07/21
Channel: BestFootDoc
Calcaneal fracture CALCANAIL FH
Calcaneal fracture CALCANAIL FH
Published: 2012/04/08
Channel: MARIOSPACEINVADERS
Balancing AO Principles in Calcaneus Fractures
Balancing AO Principles in Calcaneus Fractures
Published: 2014/06/24
Channel: UWTV
Cast application for fragmented calcaneus fracture
Cast application for fragmented calcaneus fracture
Published: 2015/05/23
Channel: Sait Ozbir
Broken heel bone recover  calcaneus fracture  update
Broken heel bone recover calcaneus fracture update
Published: 2017/03/11
Channel: Aaron Guy
Walking after Calcaneus Fracture Week #15
Walking after Calcaneus Fracture Week #15
Published: 2015/08/06
Channel: Sait Ozbir
Calcaneus Fracture Surgery Part 1
Calcaneus Fracture Surgery Part 1
Published: 2014/08/26
Channel: Kumar Shantanu Anand
ORIF of Intra articular Calcaneal Fractures with the Locking Calcaneal Plate
ORIF of Intra articular Calcaneal Fractures with the Locking Calcaneal Plate
Published: 2016/11/25
Channel: ortho tube
Calcaneal Fracture
Calcaneal Fracture
Published: 2013/11/21
Channel: FootEducation
CALCANEAL AVULSION FRACTURES ,heel bone injury - Everything You Need To Know - Dr. Nabil Ebraheim
CALCANEAL AVULSION FRACTURES ,heel bone injury - Everything You Need To Know - Dr. Nabil Ebraheim
Published: 2010/12/10
Channel: nabil ebraheim
Calcaneus Fracture with Minimal Invasive Incision
Calcaneus Fracture with Minimal Invasive Incision
Published: 2015/12/16
Channel: PFD Medical
Anatomy Of The Calcaneus - Everything You Need To Know - Dr. Nabil Ebraheim
Anatomy Of The Calcaneus - Everything You Need To Know - Dr. Nabil Ebraheim
Published: 2012/05/31
Channel: nabil ebraheim
Calcaneal Fracture Percutaneous Plate
Calcaneal Fracture Percutaneous Plate
Published: 2015/02/19
Channel: What's New in Orthopaedics
DR. IRA WEINER  "Calcaneal Fracture Frame"
DR. IRA WEINER "Calcaneal Fracture Frame"
Published: 2016/05/16
Channel: SEAL External Fixation
Week#15: Recovery from Calcaneus fracture + ORIF surgery. Walking w/ 1 crutch outdoors..
Week#15: Recovery from Calcaneus fracture + ORIF surgery. Walking w/ 1 crutch outdoors..
Published: 2013/05/20
Channel: Even Odd
Calcaneum Fracture Surgery
Calcaneum Fracture Surgery
Published: 2015/12/15
Channel: Lakshmisree T
Week #27: Walking after Calcaneus fracture + ORIF surgery
Week #27: Walking after Calcaneus fracture + ORIF surgery
Published: 2013/08/25
Channel: Even Odd
Surgical Management of Calcaneal Fractures
Surgical Management of Calcaneal Fractures
Published: 2012/02/06
Channel: Alamo Family Foot and Ankle Care
ORTHOLOC Calcaneal Fracture
ORTHOLOC Calcaneal Fracture
Published: 2015/06/01
Channel: Spiegl Foot Care
Treatment of calcaneus fracture by K wire fixation
Treatment of calcaneus fracture by K wire fixation
Published: 2016/01/03
Channel: Ortho Desk
Calcaneal Stress Fractures
Calcaneal Stress Fractures
Published: 2012/01/11
Channel: myrundoc
Calcaneus recovery first  walk
Calcaneus recovery first walk
Published: 2016/12/29
Channel: Aaron Guy
How do you treat a calcaneus stress fracture?
How do you treat a calcaneus stress fracture?
Published: 2017/08/18
Channel: Dr. David Geier
Domain Surgical - FMwand Foot ORIF Calcaneal Fracture Repair
Domain Surgical - FMwand Foot ORIF Calcaneal Fracture Repair
Published: 2012/07/12
Channel: DomainSurgical
Part 2 - Calcaneus - Heel fracture (March 2012)
Part 2 - Calcaneus - Heel fracture (March 2012)
Published: 2012/03/07
Channel: firefighterretired
Orthopaedics and Sports Medicine - March 2014 - AO Principals in Calcaneus Fractures
Orthopaedics and Sports Medicine - March 2014 - AO Principals in Calcaneus Fractures
Published: 2015/03/06
Channel: Husky Orthopaedics
3D Volumetric Rendering of Calcaneus Fractures
3D Volumetric Rendering of Calcaneus Fractures
Published: 2014/01/17
Channel: High Impact
Calcaneus fractures - ORIF vs nonop management - Debate
Calcaneus fractures - ORIF vs nonop management - Debate
Published: 2016/06/25
Channel: OrthoClips
Stress Fractures Of The Foot - Everything You Need To Know - Dr. Nabil Ebraheim
Stress Fractures Of The Foot - Everything You Need To Know - Dr. Nabil Ebraheim
Published: 2014/05/02
Channel: nabil ebraheim
Week#156: Walking after Calcaneus fracture + ORIF  - Video 2 (3 Years later)
Week#156: Walking after Calcaneus fracture + ORIF - Video 2 (3 Years later)
Published: 2016/03/20
Channel: Even Odd
Calcaneus Fracture 5 months Stairs
Calcaneus Fracture 5 months Stairs
Published: 2013/11/19
Channel: 4957davis
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WIKIPEDIA ARTICLE

From Wikipedia, the free encyclopedia
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Calcaneal fracture
Synonyms lover's fracture, Don Juan fracture
CalFrac.png
X-ray of a fractured calcaneus.
Classification and external resources
Specialty orthopedics, emergency medicine
ICD-10 S92.0
ICD-9-CM 825.0-825.2
eMedicine radio/123

Calcaneal fracture is a fracture of the calcaneus. It is usually caused by a fall from height when one lands on their feet. These fractures represent approximately 2% of all fractures but 60% of tarsal bone fractures.[1] The name lover's fracture is derived from the fact that a lover may jump from great heights while trying to escape from the lover's spouse.[2]

Signs and symptoms[edit]

The most common symptom is pain over the heel area, especially when the heel is palpated or squeezed. Patients usually have a history of recent trauma to the area or fall from a height. Other symptoms include: inability to bear weight over the involved foot, limited mobility of the foot, and limping. Upon inspection, the examiner may notice swelling, redness, and hematomas. A hematoma extending to the sole of the foot is called "Mondor Sign", and is pathognomonic for calcaneal fracture.[3][4] The heel may also become widened with associated edema due to displacement of lateral calcaneal border. Involvement of soft tissue (tendons, skin, etc.,) should be evaluated because soft tissue injury has been associated to serious complications (see below).[5][6]

Cause[edit]

Calcaneal fractures are often attributed to shearing stress adjoined with compressive forces combined with a rotary direction (Soeur, 1975[7]). These forces are typically linked to injuries in which an individual falls from a height, involvement in an automobile accident, or muscular stress where the resulting forces can lead to the trauma of fracture. Overlooked aspects of what can lead to a calcaneal fracture are the roles of osteoporosis and diabetes.

Unfortunately, the prevention of falls and automobile accidents is limited and applies to unique circumstances that should be avoided. The risk of muscular stress fractures can be reduced through stretching and weight-bearing exercise, such as strength training. In addition, footwear can influence forces that may cause a calcaneal fracture and can prevent them as well. A 2012 study conducted by Salzler[8] showed that the increasing trend toward minimalist footwear or running barefoot can lead to a variety of stress fractures including that of the calcaneus.

Osteoporosis[edit]

Bone mineral density decreases with increasing age. Osteoporotic bone loss can be prevented through an adequate intake of vitamin C and vitamin D, coupled with exercise and by being a non-smoker. A study by Cheng et al. in 1997,[9] showed that greater bone density indicated less risk for fractures in the calcaneus.

Diabetes[edit]

In 1991, Kathol[10] conducted a study which showed a correlation between calcaneal insufficiency avulsion fractures (a fracture in which the Achilles tendon removes a portion of the bone as it rescinds) and diabetes mellitus. The diabetic population is more susceptible to the risks of fracture and potential healing complications and infection that may lead to limb amputation. Diabetes can be regulated and prevented through diet and exercise.

Diagnosis[edit]

A fractured calcaneus as seen on CT

Conventional radiography is usually the initial assessment tool when a calcaneal fracture is suspected. Recommended x-ray views are (a) axial, (b) anteroposterior, (c) oblique and (d) views with dorsiflexion and internal rotation of the foot. However, conventional radiography is limited for visualization of calcaneal anatomy, especially at the subtalar joint. A CT scan is currently the imaging study of choice for evaluating calcaneal injury and has substituted conventional radiography in the classification of calcaneal fractures.[11] Axial and coronal views are obtained for proper visualization of the calcaneus, subtalar, calcaneocuboid and talonavicular joints.

Classification[edit]

Bohler's angle[12]
Gissane's angle

The calcaneus, also known as the heel bone, is the largest of the tarsal bones and articulates with the cuboid bone anteriorly and the talus bone superiorly. It is responsible for transmitting the majority of the body's weight from the talus bone to the ground.

Calcaneal fractures are categorized as intra-articular or extra-articular on the basis of subtalar joint involvement. Intra-articular fractures are more common and involve the posterior talar articular facet of the calcaneus. The Sanders classification groups these fractures into four types based on the location of the fracture at the posterior articular surface. Extra-articular fractures are less common and may be located anywhere outside the subtalar joint.[11] Extra-articular fractures are categorized depending on whether the involvement of the calcaneus is anterior (Type A), middle (Type B) or posterior (Type C).[13]

The Angle of Gissane, or "Critical Angle", is the angle formed by the downward and upward slopes of the calcaneal superior surface. On a lateral radiograph, an angle of Gissane > 130° suggests fracture of the posterior subtalar joint surface. Bohler's angle, or the "Tuber Angle", is another normal anatomic landmark seen in lateral radiographs. It is formed by the intersection of 1) a line from the highest point of the posterior articular facet to the highest point of the posterior tuberosity, and 2) a line from the former to the highest point on the anterior articular facet. Bohler's angle is normally 25° to 40°.[12] A decreased angle is indicative of a calcaneal fracture.

The Sanders classification system is the most commonly used system for categorizing intra-articular fractures. There are 4 types:

  1. Type I fractures are non-displaced fractures (displacement < 2 mm).
  2. Type II fractures consist of a single intra-articular fracture that divides the calcaneus into 2 pieces.
    • Type IIA: fracture occurs on lateral aspect of calcaneus.
    • Type IIB: fracture occurs on central aspect of calcaneus.
    • Type IIC: fracture occurs on medial aspect of calcaneus.
  3. Type III fractures consist of two intra-articular fractures that divide the calcaneus into 3 articular pieces.
    • Type IIIAB: two fracture lines are present, one lateral and one central.
    • Type IIIAC: two fracture lines are present, one lateral and one medial.
    • Type IIIBC: two fracture lines are present, one central and one medial.
  4. Type IV fractures consist of fractures with more than three intra-articular fractures.

Extra-articular fractures include all fractures that do not involve the posterior facet of the subtalar joint.

  • Type A involve the anterior calcaneus
  • Type B involve the middle calcaneus. This includes the sustentaculum tali, trochlear process and lateral process.
  • Type C involve the posterior calcaneus, the posterior tuberosity and medial tubercle included.

Treatment[edit]

Non-surgical treatment is for extra-articular fractures and Sanders Type I intra-articular fractures, provided that the calcaneal weight-bearing surface and foot function are not compromised. Physicians may choose to perform closed reduction with or without fixation (casting), or fixation alone (without reduction), depending on the individual case. Recommendations include no weight-bearing for a few weeks followed by range-of-motion exercises and progressive weight bearing for a period of 2–3 months.

Displaced intra-articular fractures require surgical intervention within 3 weeks of fracture, before bone consolidation has occurred. Conservative surgery consists of closed reduction with percutaneous fixation. This technique is associated with less wound complications, better soft tissue healing (because of less soft tissue manipulati) and decreased intraoperative time. However, this procedure has increased risk of inadequate calcaneal bone fixation, compared to open procedures.[14] Currently, open reduction with internal fixation (ORIF) is usually the preferred surgical approach when dealing with displaced intra-articular fractures. Newer, more innovative surgical techniques and equipment have decreased the incidence of intra- and post-operative complications.

Rehabilitation[edit]

Rehabilitation for a calcaneal fractures is dependent on whether surgery was required or not. Both types of rehabilitation require three phases in which only the first phase is different.

Calcaneal fracture neutral lposition
Leg Stand

Exercises that can be used for the range of motion phase can include eversion and inversion of the ankle, flexion and extension of the ankle, and a combination of the two motions to create a circular foot motion. Exercises that allow slight to full body weight to be used in the final phases include stepping forward then back, side-stepping, and leg stand.

Phases[edit]

The first phase of the rehabilitation after surgery includes keeping the foot elevated and iced for the first 2 days after the operation. After those 2 days, using crutches or a wheelchair in which there is no weight applied to the affected foot is recommended to getting around. If no operation was performed, the foot should be submitted to frequent range of motion exercises.[15] The second phase occurs 6 weeks after and consists of keeping the foot elevated and iced while resting and performing exercises in which only slight weight is applied to the affected area for the next two weeks, others recommend six weeks of this phase.[16] In this phase, range of motion exercises should be implemented if surgery was needed for the fracture. The third and final phase of rehabilitation of calcaneal fractures is to allow the full body weight to be used and use crutches or a cane if needed, between 13 weeks to a year the patient is allowed to resume normal activities.[14]

Complications[edit]

Evaluating soft-tissue involvement is the most important aspect of the clinical examination because of its association with patient outcome.[6][7] Skin blisters may become infected if medical attention is delayed, which can lead to necrotizing fasciitis or osteomyelitis, causing permanent damage to muscle or bone. Ligament and tendon involvement should also be explored. Achilles tendon injury can be seen with posterior (Type C) fractures. Since calcaneal fractures are related to falls from height, other concomitant injuries should be evaluated. Vertebral compression fractures occur in approximately 10% of these patients.[1] A trauma-focused clinical approach should be implemented; tibial, knee, femur, hip, and head injuries should be ruled out by means of history and physical exam.

References[edit]

  1. ^ a b Stoller, D. W.; Tirman, P. F. J.; Bredella, M. (2004). "Ankle and foot, osseous fractures, calcaneal fractures". Diagnostic imaging: orthopaedics. Salt Lake City: Amirsys. pp. 70–4. 
  2. ^ Lee, Patrick; Hunter, Tim B.; Taljanovic, Mihra (2004). "Musculoskeletal Colloquialisms: How Did We Come Up with These Names?". Radiographics. 24 (4): 1009–27. PMID 15256625. doi:10.1148/rg.244045015. 
  3. ^ Calcaneus Fractures at eMedicine
  4. ^ Richman, JD; Barre, PS (1986). "The plantar ecchymosis sign in fractures of the calcaneus". Clinical Orthopaedics and Related Research (207): 122–5. PMID 3720074. doi:10.1097/00003086-198606000-00022. 
  5. ^ Berry, G. K.; Stevens, D. G.; Kreder, H. J.; McKee, M.; Schemitsch, E.; Stephen, D. J. G. (2004). "Open Fractures of the Calcaneus: A Review of Treatment and Outcome". Journal of Orthopaedic Trauma. 18 (4): 202–6. PMID 15087962. doi:10.1097/00005131-200404000-00002. 
  6. ^ a b Heier, Keith A.; Infante, Anthony F.; Walling, Arthur K.; Sanders, Roy W. (2003). "Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome". The Journal of Bone and Joint Surgery. American Volume. 85–A (12): 2276–82. PMID 14668494. 
  7. ^ a b Soeur, Robert; Remy, Robert (1975). "Fractures of the calcaneus with displacement of the thalamic portion". The Journal of Bone and Joint Surgery. British Volume. 57 (4): 413–21. PMID 1194308. 
  8. ^ Salzler, Matthew J.; Bluman, Eric M.; Noonan, Samantha; Chiodo, Christopher P.; de Asla, Richard J. (2012). "Injuries Observed in Minimalist Runners". Foot & Ankle International. 33 (4): 262–6. PMID 22735197. doi:10.3113/FAI.2012.0262. 
  9. ^ Cheng, Sulin; Suominen, Harri; Sakari-Rantala, Ritva; Laukkanen, Pia; Avikainen, Veikko; Heikkinen, Eino (1997). "Calcaneal Bone Mineral Density Predicts Fracture Occurrence: A Five-Year Follow-up Study in Elderly People". Journal of Bone and Mineral Research. 12 (7): 1075–82. PMID 9200007. doi:10.1359/jbmr.1997.12.7.1075. 
  10. ^ Kathol, M H; el-Khoury, G Y; Moore, T E; Marsh, J L (1991). "Calcaneal insufficiency avulsion fractures in patients with diabetes mellitus". Radiology. 180 (3): 725–9. PMID 1871285. doi:10.1148/radiology.180.3.1871285. 
  11. ^ a b Badillo, Kenneth; Pacheco, Jose A.; Padua, Samuel O.; Gomez, Angel A.; Colon, Edgar; Vidal, Jorge A. (2011). "Multidetector CT Evaluation of Calcaneal Fractures". RadioGraphics. 31 (1): 81–92. PMID 21257934. doi:10.1148/rg.311105036. 
  12. ^ a b Page 562 in: Mark D. Miller, Stephen R. Thompson (2015). Miller's Review of Orthopaedics (7 ed.). Elsevier Health Sciences. ISBN 9780323390422. 
  13. ^ Radswiki; et al. "Calcaneal fracture". Radiopaedia. Retrieved July 20, 2017. 
  14. ^ a b Calcaneus Fractures~treatment at eMedicine
  15. ^ Godges, Joe; Klingman, Robert. "Calcaneal Fracture and Rehabilitation" (PDF). Kaiser Permanente. 
  16. ^ Hatzokos, I; Karataglis, D; Papadopoulos, P; Dimitriou, C; Christodoulou, A; Pournaras, J (2006). "Treatment of intra-articular comminuted os calcis fractures". Orthopedics. 29 (1): 25–9. PMID 16429931. 

Bibliography[edit]

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