SlideShare a Scribd company logo
1 of 15
King Edward
Medical University
Rabia Mustafa
King Edward medical university
Contents
Type IV fractures consist of fractures with more than three intrarticular fractures..........................................
Intraarticular Fractures:...........................................................................................................................................
Type C involve the posterior calcaneus, the posterior tuberosity and medial tubercle
included.......................................................................................................................................................................
Extraarticular Fractures:..........................................................................................................................................
Recovery: The recovery period of a calcaneus fracture is an important aspect in
determining how well a patient will return to his pre-injury level of activity. Patients will be
required to keep weight off of the foot for as long as three months. The other critically
important aspect of treatment is controlling swelling, especially in patients who have had
surgery. The best ways to control swelling includes elevation. Conclusions:.......................................................
References:..................................................................................................................................................................
Calcaneus Fracture:
The calcaneus is the bone in the back of the foot, commonly
referred to as the heel bone. This bone helps support the foot and
is important in normal walking motions. The joint on top of the
calcaneus is responsible for allowing the foot to rotate inwards
and outwards. Fractures of the heel bone, or calcaneus, can be
disabling injuries. They most often occur during high-energy
collisions — such as a fall from height or a motor vehicle crash.
Because of this, calcaneus fractures are often severe and may
result in long-term problems
Causes: The calcaneus can be injured in a fall, twisting
injury, or motor vehicle collision. A simple twisting injury may
result in the calcaneus being cracked. The force of a head-on car
collision may result in the bone being shattered (comminute
fracture).Different causes can result in similar fracture patterns.
For example, when landing on your feet from a fall, your body's
weight is directed downward. It drives the talus bone down into
the calcaneus. In a motor vehicle crash, the calcaneus is driven up
against the talus. In both cases, the resulting fracture patterns are
similar. The greater the impact, the more the calcaneus is
damaged.
Anatomy:
 (Left) In some injuries, the talus is forced downward and
acts like a wedge to fracture the calcaneus. (Right) This
computerized reconstruction of a calcaneus fracture shows
the amount of damage that can occur. Anatomy Particular
facets
 Superior particular surface contains three facets that
articulate with the talus.
 posterior facet is the largest and is the major weight bearing
surface
 the flexor hillocks long us tendon runs just inferior to this
structure and can be injured with errant drills/screws that
are too long
 middle facet is anteromedial on sustentaculum tali
 anterior facet is often confluent with middle facet
 Sinus tarsi
o between the middle and anterior facet lies the
interosseous sulcus (calcaneal groove) that together
with the talar sulcus makes up the sinus tarsi
 Sustentaculum tali
o project medially and supports neck of talus
o FHL passes beneath it
o deltoid and talocalcaneal ligament connect it to the
talus
 fragment remains "constant" and does not
typically move
 Bifurcate ligament
o connect the dorsal aspect of the anterior process to the
cuboid and navicular
Mechanism :
 Axial load (MVC, fall from height)
 Impaction of the talus causes a "primary" shear fx of
calcaneus and lateral wall blowout that results in two
fragments
 anteromedial fragment (contains sustentaculum tali)
 The medial fragment
 is not substantially displaced relative to the
 talus because of the medial talocalcaneal and interosseous
ligaments.
 often only minimally displaced secondary to medial
talocalcaneal and interosseous ligaments
 super lateral fragment (contain intra-particular facets)
 additional energy results in a "secondary" fx line and
additional fragments
 extension into the calcaneocuboid joint occurs in 63%
 Associated injuries
o injuries of spine in 10%
contralateral calcaneus in 10%
types of calcaneus fracture:
The Sanders Classification system is the most commonly used
system for categorizing intrarticular fractures. There are 4 types:
1. Type I fractures are non-displaced fractures (displacement <
2 mm).
2. Type II fractures consist of a single intrarticular fracture
that divides the calcaneus into 2 pieces.
o Type IIA: fracture occurs on lateral aspect of
calcaneus.
o Type IIB: fracture occurs on central aspect of
calcaneus.
o Type IIC: fracture occurs on medial aspect of
calcaneus.
3. Type III fractures consist of two intrarticular fractures that
divide the calcaneus into 3 articular pieces.
o Type IIIAB: two fracture lines are present, one lateral
and one central.
o Type IIIAC: two fracture lines are present, one lateral
and one medial.
o Type IIIBC: two fracture lines are present, one central
and one medial.
Type IV fractures consist of fractures with more than three
intrarticular fractures.
Intraarticular Fractures:
Approximately 75% of calcaneal fractures are intraarticular and
result from axial loading, which produces two separate fracture
lines: shear and compression A shear fracture occurs in the
sagittal plane and runs through the posterior facet, dividing it
into anteromedial and posterolateral fragments The fracture line
may extend anteriorly to involve the cuboid facet. The position of
this fracture line depends on the position of the foot at the time of
the shear force. If the hindfoot is in varus position, the line
extends more anteromedially; if the hindfoot is in valgus position,
the line tends to be more posterolateral. If the foot is in extreme
valgus position, the fracture line may be lateral to the posterior
facet and extraarticular. A sagittal shear fracture splits the
calcaneus into two fragments: the anteromedial or
“sustentacular” fragment and the posterolateral or “tuberosity”
fragment The medial fragment is not substantially displaced
relative to the talus because of the medial talocalcaneal and
interosseous ligaments. The lateral fragment is dislocated
laterally and remains impacted following release of the axial load,
leading to a “step off” in the posterior facet Occasionally, the
talus continues to impact on the lateral edge of the medial
fragment, creating a “double split” in it The resultant fragment is
called the “middle fragment” and typically is displaced by about
1–2 mmIntraarticular calcaneal fractures produce typical
features, including (a) loss of height due to impaction and rotation
of the tuberosity fragment, (b) increase in width due to lateral
displacement of the tuberosity fragment
Extrarticular 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.
Extraarticular Fractures:
Extraarticular fractures account for approximately 25%–30% of
all calcaneal fractures. All fractures that do not involve the
posterior facet are included in this category. Extraarticular
calcaneal fractures are classified as (a) anterior process fractures;
(b) fractures of the mid calcaneus, which includes the body,
sustentaculum tali, peroneal tubercle, and lateral calcaneal
process; and (c) fractures of the posterior calcaneus, which
include those of the tuberosity and medial calcaneal tubercle
When contemplating extraarticular calcaneal fractures, it is
important to differentiate complex fractures that separate
articular facets and distort the three-dimensional anatomy of the
subtalar joint from the more simple extraarticular fractures.
Anterior process fractures are uncommon and are usually
produced by forced inversion that results in increased tension
across the bifurcate ligament which connects the anterior process
to the cuboid and navicular Other mechanisms include forced
abduction of the forefoot with a fixed calcaneus and exaggerated
dorsiflexion .Patients often present with localized pain and
commonly without deformity. The fracture is best seen on oblique
views and may not be seen on anteroposterior and lateral views.
CT is particularly helpful for evaluation of anterior process
fractures. Protected weight bearing is the usual treatment for
small fractures. Displaced fractures involving more than 25% of
the calcaneocuboid articular surface are usually treated with
open reduction and internal fixation .Nonunion is the most
common complication.
Symptoms:
The most common symptoms of a calcaneus fracture are:
 Pain
 Bruising
 Swelling
 Heel deformity
 Inability to put weight on the heel or walk
Imaging:
Im AP/LAT foot
 Bohler angle (normal is 25-40 degrees)
 flattening (deceased angle) represents collapse of the
posterior facet
 measured by angle between the following two lines
 line connecting anterior process and highest point on
posterior articular surface
 line connectin highest point on posterior articular surface
and superior tuberosity
 Gissane angle (normal is 130-145 degrees)
 an increase represents collapse of posterior facet
 Harris view
 allows visualization of subtalar joint involvement,
comminution, loss of height, widening, and impingement on
peroneal space
 take with foot maximally dorsiflexed and beam angled at 45
degrees
 Broden views
 allows visualization of posterior face
 ankle internally rotated 40 degrees and ankle in neutral
dorsiflexion. Views taken at 10, 20, 30, 40 degrees
 largely replaced by CT scan
 AP ankle
look for lateral wall extrusion and impingement
 CT scan is gold standard
 MRI typically used only to diagnose calcaneal stress
fractures in the presence of normal radiographs and/or
uncertain diganosis
Tests:
Other tests that may help your doctor confirm your diagnosis
include:
X-rays. This test is the most common and widely available
diagnostic imaging technique. X-rays create images of dense
structures, like bone, so they are particularly useful in showing
fractures.
Computed tomography (CT) scan. After reviewing your
x-rays, your doctor may recommend a CT scan of your foot. This
imaging tool combines x-rays with computer technology to
produce a more detailed, cross-sectional image of your body. It
can provide your doctor with valuable information about the
severity of the fracture. Studying CT scans helps your doctor plan
your treatment. He or she will often show you the images to help
you understand the nature and severity of your injury.
HISTORICAL BACK GROUND:
 1908 cotton and willson
Recommended closed treatment with use of a medially
placed sandburg a laterally placed felt pad and a hammer to
reduce the lateral wall and “reimpact” pf the fracture
 1920 s
Abandoned the treatment of acute fractures altogather and
had turned instead of healed malunious
 1931 bohler
Advocated open reduction
Technical problems associated with operative treatment
Infection, malunion, non-union and possible need for
amputation
 1935 Conn
Delayed primary triple arthrodesis
 1943 gallie
Subtalar arthrodesis as definitive treatment only for
fractures that healed this techniquee became standard for
healed malunited calcaneal fracture
 1948 palmar
Dissastified with both nonoperative and late treatment
Described the operativeoperative treatment of acute
displaced intra articular calcaneal
Standard lateral kocher approach to reduce the joint
Holding up the fragment with bone graft
He stated that is patient did well and that many returend to
work
 1952 essex
Reported similar findings
In the last twenty years
 Better anasthesia
 Antibiotics
 Asif principles of internal fixataion
 Computed tomography
 Flucoscopy
Goog outcomes with use of operative intervention
Treatment:
In planning your treatment, your doctor will consider several
things, including:
 The cause of your injury
 Your overall health
 The severity of your injury
 The extent of soft tissue damage
Because most calcaneus fractures cause the bone to widen, the
goal of treatment is to restore the normal anatomy of the heel. In
general, patients whose normal heel anatomy is restored have
better overall outcomes. Recreating normal anatomy, however,
most often involves surgery. Surgery is associated with a higher
risk of complications.
Your doctor will discuss the treatment options with you.
Surgical Treatment:
If the bones have shifted out of place (displaced), you may need
surgery.
Timing of surgery. If the skin around your fracture has not been
broken, your doctor may recommend waiting until swelling has
gone down before having surgery. Keeping your leg immobilized
and elevated for several days will decrease swelling. It also gives
skin that has been stretched a chance to recover. This waiting
period before the operation often improves your overall recovery
from surgery and decreases your risk of infection.
Open fractures, however, expose the fracture site to the
environment. They urgently need to be cleansed and require
immediate surgery.
Early surgery is also often recommended for an avulsion fracture.
Although uncommon, a piece of the calcaneus can be pulled off
when the Achilles tendon tears away from the bone (avulsion).
For this type of fracture, early surgery can decrease the risk of
injury to the skin around the Achilles tendon.
Surgical procedure:
The following procedures are used for various types of calcaneus
fractures.
 Open reduction and internal fixation. During this operation,
the bone fragments are first repositioned (reduced) into
their normal alignment. They are held together with
special screws or metal plates and screws.
 Percutaneous screw fixation. Sometimes, if the bone pieces
are large, they can be moved back into place by either
pushing or pulling on them without making a large
incision. Special screws can be placed through small
incisions to hold your bone pieces together.
(Left) A displaced fracture of the calcaneus. (Right) The fracture
has been reduced and the bones held in place with screws.
The typical method of realigning the bone fragments and holding
them in place with metal plates and screws.
Nonsurgical Treatment:
If the pieces of broken bone have not been displaced by the force
of the injury, you may not need surgery. Casting or some other
form of immobilization may be an option. This will keep the
broken ends in proper position while they heal.
You will not be able to put any weight on your foot until the bone
is completely healed. This may take 6 to 8 weeks, and perhaps
longer.
Recovery:
The recovery period of a calcaneus fracture is an important
aspect in determining how well a patient will return to his pre-
injury level of activity. Patients will be required to keep weight off
of the foot for as long as three months. The other critically
important aspect of treatment is controlling swelling, especially in
patients who have had surgery. The best ways to control swelling
includes elevation. Conclusions:
Calcaneal fractures are complex injuries that commonly occur in
male patients and that result in substantial morbidity. Recently,
there has been an exponential proliferation of CT examinations of
trauma patients who have sustained multiple injuries. In addition,
dramatic advances have occurred in imaging technology,
particularly multi-detector CT and image processing. This
combination has resulted in dramatic improvements in the
visualization of calcaneal injuries, which in turn has led to
improved fracture characterization for the trauma patient
References:
1. ↵
HartyM. Anatomic considerations in injuries of the
calcaneus. Orthop Clin North Am1973; 4: 179–183.
Medline
2. ↵
FitzgibbonsT, McMullen ST, Mormino MA. Fractures and
dislocations of the calcaneus. In: Bucholz RW, Heckman
JD, eds. Rockwood and Green’s fractures in adults.
Philadelphia, Pa: Lippincott Williams & Wilkins, 2001;
2133–2179.
3. ↵
GrayH. Anatomy of the human body. Philadelphia, Pa:
Lea & Febiger, 1918; Bartelby.com; 2000.
4. ↵
CarrJB. Mechanism and pathoanatomy of the
intraarticular calcaneal fracture. Clin Orthop Relat
Res1993; 290: 36–40.
5. ↵
BurdeauxBD. Reduction of calcaneal fractures by the
McReynolds medial approach technique and its
experimental basis. Clin Orthop Relat Res1983; 177: 87–
103.
6. ↵
BuckwalterKA, Rydberg J, Kopecky KK, Crow K, Yang EL.
Musculoskeletal imaging with multi-slice CT. AJR Am J
Roentgenol2001; 176: 979–986.
FREE Full Text
7. ↵
LinsenmaierU, Brunner U, Schoning A, et al.
Classification of calcaneal fractures by spiral computed
tomography: implications for surgical treatment. Eur
Radiol2003; 13: 2315–2322.
CrossRefMedline
8. ↵
CarrJB, Hamilton JJ, Bear LS. Experimental intra-
articular calcaneal fractures: anatomic basis for a new
classification. Foot Ankle1989; 10: 81–87.
Medline
9. ↵
EastwoodDM, Phipp L. Intra-articular fractures of the
calcaneus: why such controversy? Injury1997; 28: 247–
259.
CrossRefMedline

More Related Content

What's hot

Talus fructures classification and managment
Talus fructures classification and managment Talus fructures classification and managment
Talus fructures classification and managment drhakim90
 
Templating X-rays in THR
Templating X-rays in THR Templating X-rays in THR
Templating X-rays in THR Dr. Bushu Harna
 
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Vaibhav Bagaria
 
Posteromedial and posterolateral approach to knee
Posteromedial and posterolateral approach to kneePosteromedial and posterolateral approach to knee
Posteromedial and posterolateral approach to kneeBipulBorthakur
 
Capitellum fractures
Capitellum fracturesCapitellum fractures
Capitellum fracturesApoorv Jain
 
BIOMECHANICS OF HIP JOINT
BIOMECHANICS OF HIP JOINTBIOMECHANICS OF HIP JOINT
BIOMECHANICS OF HIP JOINTdhidhi george
 
Reverse shoulder biomechanics
Reverse shoulder biomechanicsReverse shoulder biomechanics
Reverse shoulder biomechanicsMoby Parsons
 
tension band wiring
tension band wiringtension band wiring
tension band wiringAnand Dev
 
Distal radioulnar joint injuries
Distal radioulnar joint injuriesDistal radioulnar joint injuries
Distal radioulnar joint injuriesSunil Poonia
 
CORA (center of rotation of angulation)
CORA (center of rotation of angulation)CORA (center of rotation of angulation)
CORA (center of rotation of angulation)Morshed Abir
 
Osteotomy around knee dr shankar jangid (1)
Osteotomy around knee dr shankar jangid (1)Osteotomy around knee dr shankar jangid (1)
Osteotomy around knee dr shankar jangid (1)ShankarJangid5
 
Leg Calve Perthes disease
Leg Calve Perthes disease Leg Calve Perthes disease
Leg Calve Perthes disease darshanck89
 
Principles of deformity correction
Principles of deformity correctionPrinciples of deformity correction
Principles of deformity correctionAbdulla Kamal
 

What's hot (20)

Patella Instability
Patella InstabilityPatella Instability
Patella Instability
 
Talus fructures classification and managment
Talus fructures classification and managment Talus fructures classification and managment
Talus fructures classification and managment
 
Templating X-rays in THR
Templating X-rays in THR Templating X-rays in THR
Templating X-rays in THR
 
Acetabular defects
Acetabular defectsAcetabular defects
Acetabular defects
 
Calcaneal fractures
Calcaneal fracturesCalcaneal fractures
Calcaneal fractures
 
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...
Hoffa's Fracture: Diagnosis, management & New Classification System by BAGARI...
 
Posteromedial and posterolateral approach to knee
Posteromedial and posterolateral approach to kneePosteromedial and posterolateral approach to knee
Posteromedial and posterolateral approach to knee
 
Capitellum fractures
Capitellum fracturesCapitellum fractures
Capitellum fractures
 
Ankle arthrodesis
Ankle arthrodesisAnkle arthrodesis
Ankle arthrodesis
 
BIOMECHANICS OF HIP JOINT
BIOMECHANICS OF HIP JOINTBIOMECHANICS OF HIP JOINT
BIOMECHANICS OF HIP JOINT
 
Reverse shoulder biomechanics
Reverse shoulder biomechanicsReverse shoulder biomechanics
Reverse shoulder biomechanics
 
tension band wiring
tension band wiringtension band wiring
tension band wiring
 
Distal radioulnar joint injuries
Distal radioulnar joint injuriesDistal radioulnar joint injuries
Distal radioulnar joint injuries
 
Ankle fractures
Ankle fractures Ankle fractures
Ankle fractures
 
Blounts disease
Blounts diseaseBlounts disease
Blounts disease
 
CORA (center of rotation of angulation)
CORA (center of rotation of angulation)CORA (center of rotation of angulation)
CORA (center of rotation of angulation)
 
sarmiento principle
sarmiento principlesarmiento principle
sarmiento principle
 
Osteotomy around knee dr shankar jangid (1)
Osteotomy around knee dr shankar jangid (1)Osteotomy around knee dr shankar jangid (1)
Osteotomy around knee dr shankar jangid (1)
 
Leg Calve Perthes disease
Leg Calve Perthes disease Leg Calve Perthes disease
Leg Calve Perthes disease
 
Principles of deformity correction
Principles of deformity correctionPrinciples of deformity correction
Principles of deformity correction
 

Viewers also liked

Calcaneal fractures --sito--29th aug 2015
Calcaneal fractures --sito--29th aug 2015Calcaneal fractures --sito--29th aug 2015
Calcaneal fractures --sito--29th aug 2015Uday Bangalore
 
Calcaneal Fractures
Calcaneal FracturesCalcaneal Fractures
Calcaneal FracturesThanh Nguyen
 
Calcaneus fractures by dr sidhu
Calcaneus fractures by dr sidhuCalcaneus fractures by dr sidhu
Calcaneus fractures by dr sidhuHarsimran Sidhu
 
Calcaneal fractures new
Calcaneal fractures newCalcaneal fractures new
Calcaneal fractures newThanh Nguyen
 
Calcaneal fractures
Calcaneal fracturesCalcaneal fractures
Calcaneal fracturesRohit Vikas
 

Viewers also liked (6)

Calcaneal fractures --sito--29th aug 2015
Calcaneal fractures --sito--29th aug 2015Calcaneal fractures --sito--29th aug 2015
Calcaneal fractures --sito--29th aug 2015
 
Calcaneal Fractures
Calcaneal FracturesCalcaneal Fractures
Calcaneal Fractures
 
Calcaneus fractures by dr sidhu
Calcaneus fractures by dr sidhuCalcaneus fractures by dr sidhu
Calcaneus fractures by dr sidhu
 
Calcaneal fractures new
Calcaneal fractures newCalcaneal fractures new
Calcaneal fractures new
 
calcaneal fracture
calcaneal fracturecalcaneal fracture
calcaneal fracture
 
Calcaneal fractures
Calcaneal fracturesCalcaneal fractures
Calcaneal fractures
 

Similar to Calcaneus fracture

Lower limb fractures
Lower limb fracturesLower limb fractures
Lower limb fracturesairwave12
 
lowerlimbfractures-141119052341-conversion-gate01.pdf
lowerlimbfractures-141119052341-conversion-gate01.pdflowerlimbfractures-141119052341-conversion-gate01.pdf
lowerlimbfractures-141119052341-conversion-gate01.pdfDominicLaibuni
 
Spinal trauma IMAGING
Spinal trauma  IMAGINGSpinal trauma  IMAGING
Spinal trauma IMAGINGSanal Kumar
 
Injuries of the ankle joint which can occur
Injuries of the ankle joint which can occurInjuries of the ankle joint which can occur
Injuries of the ankle joint which can occurmdjstf48sq
 
Fracture and dislocation of the shoulder girdle
Fracture and dislocation of the shoulder girdleFracture and dislocation of the shoulder girdle
Fracture and dislocation of the shoulder girdleomar ababneh
 
Cervical spine trauma asif.pptx
Cervical spine trauma asif.pptxCervical spine trauma asif.pptx
Cervical spine trauma asif.pptxAsifAliJatoi2
 
Important radiological classification of fracture and AVN
Important radiological classification of fracture and AVNImportant radiological classification of fracture and AVN
Important radiological classification of fracture and AVNDr pradeep Kumar
 
Upper and Lower Extremity fractures
Upper and Lower Extremity fracturesUpper and Lower Extremity fractures
Upper and Lower Extremity fracturesAubreyvale Sagun
 
Cervical trauma
Cervical traumaCervical trauma
Cervical traumaAli Jiwani
 
Fracture around elbow.pptx
Fracture around elbow.pptxFracture around elbow.pptx
Fracture around elbow.pptxReza Hambali
 
26. acetabular fractures anatomy, evaluation and classification - muhammad...
26. acetabular fractures   anatomy, evaluation and classification  - muhammad...26. acetabular fractures   anatomy, evaluation and classification  - muhammad...
26. acetabular fractures anatomy, evaluation and classification - muhammad...Muhammad Abdelghani
 
Rad Lecttony 3 Extremities
Rad Lecttony 3 ExtremitiesRad Lecttony 3 Extremities
Rad Lecttony 3 ExtremitiesMiami Dade
 
Upper extremity fracture principles
Upper extremity fracture principlesUpper extremity fracture principles
Upper extremity fracture principlesYudiNug1
 
elbow and wrist and hand fracture with management
elbow and wrist and hand fracture with managementelbow and wrist and hand fracture with management
elbow and wrist and hand fracture with managementkajalgoel8
 

Similar to Calcaneus fracture (20)

Lower limb fractures
Lower limb fracturesLower limb fractures
Lower limb fractures
 
lowerlimbfractures-141119052341-conversion-gate01.pdf
lowerlimbfractures-141119052341-conversion-gate01.pdflowerlimbfractures-141119052341-conversion-gate01.pdf
lowerlimbfractures-141119052341-conversion-gate01.pdf
 
Spinal trauma IMAGING
Spinal trauma  IMAGINGSpinal trauma  IMAGING
Spinal trauma IMAGING
 
Injuries of the ankle joint which can occur
Injuries of the ankle joint which can occurInjuries of the ankle joint which can occur
Injuries of the ankle joint which can occur
 
Fracture and dislocation of the shoulder girdle
Fracture and dislocation of the shoulder girdleFracture and dislocation of the shoulder girdle
Fracture and dislocation of the shoulder girdle
 
Orthopedics 5th year, 2nd lecture (Dr. Ali A.Nabi)
Orthopedics 5th year, 2nd lecture (Dr. Ali A.Nabi)Orthopedics 5th year, 2nd lecture (Dr. Ali A.Nabi)
Orthopedics 5th year, 2nd lecture (Dr. Ali A.Nabi)
 
Cervical spine trauma asif.pptx
Cervical spine trauma asif.pptxCervical spine trauma asif.pptx
Cervical spine trauma asif.pptx
 
Important radiological classification of fracture and AVN
Important radiological classification of fracture and AVNImportant radiological classification of fracture and AVN
Important radiological classification of fracture and AVN
 
Upper and Lower Extremity fractures
Upper and Lower Extremity fracturesUpper and Lower Extremity fractures
Upper and Lower Extremity fractures
 
Cervical trauma
Cervical traumaCervical trauma
Cervical trauma
 
Clavicle fracture
Clavicle fractureClavicle fracture
Clavicle fracture
 
Fracture around elbow.pptx
Fracture around elbow.pptxFracture around elbow.pptx
Fracture around elbow.pptx
 
Cervical spine fractures muhamma
Cervical spine fractures muhammaCervical spine fractures muhamma
Cervical spine fractures muhamma
 
26. acetabular fractures anatomy, evaluation and classification - muhammad...
26. acetabular fractures   anatomy, evaluation and classification  - muhammad...26. acetabular fractures   anatomy, evaluation and classification  - muhammad...
26. acetabular fractures anatomy, evaluation and classification - muhammad...
 
Cervical spine fractures muhamma
Cervical spine fractures muhammaCervical spine fractures muhamma
Cervical spine fractures muhamma
 
Fracture talus
Fracture talusFracture talus
Fracture talus
 
diagnostico por imagen musculo esqueletico
diagnostico por imagen musculo esqueleticodiagnostico por imagen musculo esqueletico
diagnostico por imagen musculo esqueletico
 
Rad Lecttony 3 Extremities
Rad Lecttony 3 ExtremitiesRad Lecttony 3 Extremities
Rad Lecttony 3 Extremities
 
Upper extremity fracture principles
Upper extremity fracture principlesUpper extremity fracture principles
Upper extremity fracture principles
 
elbow and wrist and hand fracture with management
elbow and wrist and hand fracture with managementelbow and wrist and hand fracture with management
elbow and wrist and hand fracture with management
 

More from Ainaa Khan

Upper limb prosthesis
Upper limb prosthesis Upper limb prosthesis
Upper limb prosthesis Ainaa Khan
 
Pathological gait
Pathological gaitPathological gait
Pathological gaitAinaa Khan
 
Orthotic treatment of polio myelitis
Orthotic treatment of polio myelitisOrthotic treatment of polio myelitis
Orthotic treatment of polio myelitisAinaa Khan
 
Neural tube defects
Neural tube defectsNeural tube defects
Neural tube defectsAinaa Khan
 
Deformities related to cerebral palsy and their orthotic
Deformities related to cerebral palsy and their orthoticDeformities related to cerebral palsy and their orthotic
Deformities related to cerebral palsy and their orthoticAinaa Khan
 
Anatomy and physiology of muscle
Anatomy and physiology of muscleAnatomy and physiology of muscle
Anatomy and physiology of muscleAinaa Khan
 

More from Ainaa Khan (10)

Upper limb prosthesis
Upper limb prosthesis Upper limb prosthesis
Upper limb prosthesis
 
Torticollis
TorticollisTorticollis
Torticollis
 
Spinal cord
Spinal cordSpinal cord
Spinal cord
 
Scoilosis
ScoilosisScoilosis
Scoilosis
 
Pathological gait
Pathological gaitPathological gait
Pathological gait
 
Orthotic treatment of polio myelitis
Orthotic treatment of polio myelitisOrthotic treatment of polio myelitis
Orthotic treatment of polio myelitis
 
Neural tube defects
Neural tube defectsNeural tube defects
Neural tube defects
 
Fixed pulley
Fixed pulleyFixed pulley
Fixed pulley
 
Deformities related to cerebral palsy and their orthotic
Deformities related to cerebral palsy and their orthoticDeformities related to cerebral palsy and their orthotic
Deformities related to cerebral palsy and their orthotic
 
Anatomy and physiology of muscle
Anatomy and physiology of muscleAnatomy and physiology of muscle
Anatomy and physiology of muscle
 

Recently uploaded

ESC HF 2024 Spotlights Day-2.pptx heart failure
ESC HF 2024 Spotlights Day-2.pptx heart failureESC HF 2024 Spotlights Day-2.pptx heart failure
ESC HF 2024 Spotlights Day-2.pptx heart failuremahiavy26
 
Gallbladder Double-Diverticular: A Case Report المرارة مزدوجة التج: تقرير حالة
Gallbladder Double-Diverticular: A Case Report  المرارة مزدوجة التج: تقرير حالةGallbladder Double-Diverticular: A Case Report  المرارة مزدوجة التج: تقرير حالة
Gallbladder Double-Diverticular: A Case Report المرارة مزدوجة التج: تقرير حالةMohamad محمد Al-Gailani الكيلاني
 
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...marcuskenyatta275
 
The Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project
 
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose AcademicsCytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose AcademicsMedicoseAcademics
 
Post-Cycle Therapy (PCT) in bodybuilding docx.pdf
Post-Cycle Therapy (PCT) in bodybuilding  docx.pdfPost-Cycle Therapy (PCT) in bodybuilding  docx.pdf
Post-Cycle Therapy (PCT) in bodybuilding docx.pdfAea.ltd
 
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptxThe Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptxDr. Rabia Inam Gandapore
 
Failure to thrive in neonates and infants + pediatric case.pptx
Failure to thrive in neonates and infants  + pediatric case.pptxFailure to thrive in neonates and infants  + pediatric case.pptx
Failure to thrive in neonates and infants + pediatric case.pptxclaviclebrown44
 
Mgr university bsc nursing adult health previous question paper with answers
Mgr university  bsc nursing adult health previous question paper with answersMgr university  bsc nursing adult health previous question paper with answers
Mgr university bsc nursing adult health previous question paper with answersShafnaP5
 
Treatment Choices for Slip Disc at Gokuldas Hospital
Treatment Choices for Slip Disc at Gokuldas HospitalTreatment Choices for Slip Disc at Gokuldas Hospital
Treatment Choices for Slip Disc at Gokuldas HospitalGokuldas Hospital
 
Varicose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas HospitalVaricose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas HospitalGokuldas Hospital
 
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341Sherrylee83
 
Tips to Choose the Best Psychiatrists in Indore
Tips to Choose the Best Psychiatrists in IndoreTips to Choose the Best Psychiatrists in Indore
Tips to Choose the Best Psychiatrists in IndoreGokuldas Hospital
 
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose AcademicsHistology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose AcademicsMedicoseAcademics
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsMedicoseAcademics
 
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...JRRolfNeuqelet
 
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsNaveen Gokul Dr
 
Is Rheumatoid Arthritis a Metabolic Disorder.pptx
Is Rheumatoid Arthritis a Metabolic Disorder.pptxIs Rheumatoid Arthritis a Metabolic Disorder.pptx
Is Rheumatoid Arthritis a Metabolic Disorder.pptxSamar Tharwat
 
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.Gawad
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.GawadHemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.Gawad
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.GawadNephroTube - Dr.Gawad
 

Recently uploaded (20)

ESC HF 2024 Spotlights Day-2.pptx heart failure
ESC HF 2024 Spotlights Day-2.pptx heart failureESC HF 2024 Spotlights Day-2.pptx heart failure
ESC HF 2024 Spotlights Day-2.pptx heart failure
 
Gallbladder Double-Diverticular: A Case Report المرارة مزدوجة التج: تقرير حالة
Gallbladder Double-Diverticular: A Case Report  المرارة مزدوجة التج: تقرير حالةGallbladder Double-Diverticular: A Case Report  المرارة مزدوجة التج: تقرير حالة
Gallbladder Double-Diverticular: A Case Report المرارة مزدوجة التج: تقرير حالة
 
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
TEST BANK For Huether and McCance's Understanding Pathophysiology, Canadian 2...
 
The Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - SubconsciousThe Clean Living Project Episode 24 - Subconscious
The Clean Living Project Episode 24 - Subconscious
 
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose AcademicsCytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
Cytoskeleton and Cell Inclusions - Dr Muhammad Ali Rabbani - Medicose Academics
 
Post-Cycle Therapy (PCT) in bodybuilding docx.pdf
Post-Cycle Therapy (PCT) in bodybuilding  docx.pdfPost-Cycle Therapy (PCT) in bodybuilding  docx.pdf
Post-Cycle Therapy (PCT) in bodybuilding docx.pdf
 
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
Best medicine 100% Effective&Safe Mifepristion ௵+918133066128௹Abortion pills ...
 
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptxThe Orbit & its contents by Dr. Rabia I. Gandapore.pptx
The Orbit & its contents by Dr. Rabia I. Gandapore.pptx
 
Failure to thrive in neonates and infants + pediatric case.pptx
Failure to thrive in neonates and infants  + pediatric case.pptxFailure to thrive in neonates and infants  + pediatric case.pptx
Failure to thrive in neonates and infants + pediatric case.pptx
 
Mgr university bsc nursing adult health previous question paper with answers
Mgr university  bsc nursing adult health previous question paper with answersMgr university  bsc nursing adult health previous question paper with answers
Mgr university bsc nursing adult health previous question paper with answers
 
Treatment Choices for Slip Disc at Gokuldas Hospital
Treatment Choices for Slip Disc at Gokuldas HospitalTreatment Choices for Slip Disc at Gokuldas Hospital
Treatment Choices for Slip Disc at Gokuldas Hospital
 
Varicose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas HospitalVaricose Veins Treatment Aftercare Tips by Gokuldas Hospital
Varicose Veins Treatment Aftercare Tips by Gokuldas Hospital
 
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341
Sell pmk powder cas 28578-16-7 from pmk supplier Telegram +85297504341
 
Tips to Choose the Best Psychiatrists in Indore
Tips to Choose the Best Psychiatrists in IndoreTips to Choose the Best Psychiatrists in Indore
Tips to Choose the Best Psychiatrists in Indore
 
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose AcademicsHistology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
Histology of Epithelium - Dr Muhammad Ali Rabbani - Medicose Academics
 
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose AcademicsConnective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
Connective Tissue II - Dr Muhammad Ali Rabbani - Medicose Academics
 
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
VIII.1 Nursing Interventions to Promote Healthy Psychological responses, SELF...
 
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancementsCAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
CAD CAM DENTURES IN PROSTHODONTICS : Dental advancements
 
Is Rheumatoid Arthritis a Metabolic Disorder.pptx
Is Rheumatoid Arthritis a Metabolic Disorder.pptxIs Rheumatoid Arthritis a Metabolic Disorder.pptx
Is Rheumatoid Arthritis a Metabolic Disorder.pptx
 
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.Gawad
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.GawadHemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.Gawad
Hemodialysis: Chapter 1, Physiological Principles of Hemodialysis - Dr.Gawad
 

Calcaneus fracture

  • 1. King Edward Medical University Rabia Mustafa King Edward medical university
  • 2. Contents Type IV fractures consist of fractures with more than three intrarticular fractures.......................................... Intraarticular Fractures:........................................................................................................................................... Type C involve the posterior calcaneus, the posterior tuberosity and medial tubercle included....................................................................................................................................................................... Extraarticular Fractures:.......................................................................................................................................... Recovery: The recovery period of a calcaneus fracture is an important aspect in determining how well a patient will return to his pre-injury level of activity. Patients will be required to keep weight off of the foot for as long as three months. The other critically important aspect of treatment is controlling swelling, especially in patients who have had surgery. The best ways to control swelling includes elevation. Conclusions:....................................................... References:.................................................................................................................................................................. Calcaneus Fracture: The calcaneus is the bone in the back of the foot, commonly referred to as the heel bone. This bone helps support the foot and is important in normal walking motions. The joint on top of the calcaneus is responsible for allowing the foot to rotate inwards and outwards. Fractures of the heel bone, or calcaneus, can be disabling injuries. They most often occur during high-energy collisions — such as a fall from height or a motor vehicle crash. Because of this, calcaneus fractures are often severe and may result in long-term problems Causes: The calcaneus can be injured in a fall, twisting injury, or motor vehicle collision. A simple twisting injury may result in the calcaneus being cracked. The force of a head-on car collision may result in the bone being shattered (comminute fracture).Different causes can result in similar fracture patterns. For example, when landing on your feet from a fall, your body's
  • 3. weight is directed downward. It drives the talus bone down into the calcaneus. In a motor vehicle crash, the calcaneus is driven up against the talus. In both cases, the resulting fracture patterns are similar. The greater the impact, the more the calcaneus is damaged. Anatomy:  (Left) In some injuries, the talus is forced downward and acts like a wedge to fracture the calcaneus. (Right) This computerized reconstruction of a calcaneus fracture shows the amount of damage that can occur. Anatomy Particular facets  Superior particular surface contains three facets that articulate with the talus.  posterior facet is the largest and is the major weight bearing surface  the flexor hillocks long us tendon runs just inferior to this structure and can be injured with errant drills/screws that are too long  middle facet is anteromedial on sustentaculum tali  anterior facet is often confluent with middle facet  Sinus tarsi o between the middle and anterior facet lies the interosseous sulcus (calcaneal groove) that together with the talar sulcus makes up the sinus tarsi  Sustentaculum tali o project medially and supports neck of talus o FHL passes beneath it
  • 4. o deltoid and talocalcaneal ligament connect it to the talus  fragment remains "constant" and does not typically move  Bifurcate ligament o connect the dorsal aspect of the anterior process to the cuboid and navicular Mechanism :  Axial load (MVC, fall from height)  Impaction of the talus causes a "primary" shear fx of calcaneus and lateral wall blowout that results in two fragments  anteromedial fragment (contains sustentaculum tali)  The medial fragment  is not substantially displaced relative to the  talus because of the medial talocalcaneal and interosseous ligaments.  often only minimally displaced secondary to medial talocalcaneal and interosseous ligaments  super lateral fragment (contain intra-particular facets)  additional energy results in a "secondary" fx line and additional fragments  extension into the calcaneocuboid joint occurs in 63%  Associated injuries o injuries of spine in 10% contralateral calcaneus in 10% types of calcaneus fracture: The Sanders Classification system is the most commonly used system for categorizing intrarticular fractures. There are 4 types:
  • 5. 1. Type I fractures are non-displaced fractures (displacement < 2 mm). 2. Type II fractures consist of a single intrarticular fracture that divides the calcaneus into 2 pieces. o Type IIA: fracture occurs on lateral aspect of calcaneus. o Type IIB: fracture occurs on central aspect of calcaneus. o Type IIC: fracture occurs on medial aspect of calcaneus. 3. Type III fractures consist of two intrarticular fractures that divide the calcaneus into 3 articular pieces. o Type IIIAB: two fracture lines are present, one lateral and one central. o Type IIIAC: two fracture lines are present, one lateral and one medial. o Type IIIBC: two fracture lines are present, one central and one medial. Type IV fractures consist of fractures with more than three intrarticular fractures. Intraarticular Fractures: Approximately 75% of calcaneal fractures are intraarticular and result from axial loading, which produces two separate fracture lines: shear and compression A shear fracture occurs in the sagittal plane and runs through the posterior facet, dividing it into anteromedial and posterolateral fragments The fracture line may extend anteriorly to involve the cuboid facet. The position of this fracture line depends on the position of the foot at the time of the shear force. If the hindfoot is in varus position, the line extends more anteromedially; if the hindfoot is in valgus position, the line tends to be more posterolateral. If the foot is in extreme valgus position, the fracture line may be lateral to the posterior facet and extraarticular. A sagittal shear fracture splits the calcaneus into two fragments: the anteromedial or “sustentacular” fragment and the posterolateral or “tuberosity”
  • 6. fragment The medial fragment is not substantially displaced relative to the talus because of the medial talocalcaneal and interosseous ligaments. The lateral fragment is dislocated laterally and remains impacted following release of the axial load, leading to a “step off” in the posterior facet Occasionally, the talus continues to impact on the lateral edge of the medial fragment, creating a “double split” in it The resultant fragment is called the “middle fragment” and typically is displaced by about 1–2 mmIntraarticular calcaneal fractures produce typical features, including (a) loss of height due to impaction and rotation of the tuberosity fragment, (b) increase in width due to lateral displacement of the tuberosity fragment Extrarticular 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. Extraarticular Fractures: Extraarticular fractures account for approximately 25%–30% of all calcaneal fractures. All fractures that do not involve the posterior facet are included in this category. Extraarticular calcaneal fractures are classified as (a) anterior process fractures; (b) fractures of the mid calcaneus, which includes the body,
  • 7. sustentaculum tali, peroneal tubercle, and lateral calcaneal process; and (c) fractures of the posterior calcaneus, which include those of the tuberosity and medial calcaneal tubercle When contemplating extraarticular calcaneal fractures, it is important to differentiate complex fractures that separate articular facets and distort the three-dimensional anatomy of the subtalar joint from the more simple extraarticular fractures. Anterior process fractures are uncommon and are usually produced by forced inversion that results in increased tension across the bifurcate ligament which connects the anterior process to the cuboid and navicular Other mechanisms include forced abduction of the forefoot with a fixed calcaneus and exaggerated dorsiflexion .Patients often present with localized pain and commonly without deformity. The fracture is best seen on oblique views and may not be seen on anteroposterior and lateral views. CT is particularly helpful for evaluation of anterior process fractures. Protected weight bearing is the usual treatment for small fractures. Displaced fractures involving more than 25% of the calcaneocuboid articular surface are usually treated with open reduction and internal fixation .Nonunion is the most common complication. Symptoms: The most common symptoms of a calcaneus fracture are:
  • 8.  Pain  Bruising  Swelling  Heel deformity  Inability to put weight on the heel or walk Imaging: Im AP/LAT foot  Bohler angle (normal is 25-40 degrees)  flattening (deceased angle) represents collapse of the posterior facet  measured by angle between the following two lines  line connecting anterior process and highest point on posterior articular surface  line connectin highest point on posterior articular surface and superior tuberosity  Gissane angle (normal is 130-145 degrees)  an increase represents collapse of posterior facet  Harris view  allows visualization of subtalar joint involvement, comminution, loss of height, widening, and impingement on peroneal space  take with foot maximally dorsiflexed and beam angled at 45 degrees  Broden views  allows visualization of posterior face
  • 9.  ankle internally rotated 40 degrees and ankle in neutral dorsiflexion. Views taken at 10, 20, 30, 40 degrees  largely replaced by CT scan  AP ankle look for lateral wall extrusion and impingement  CT scan is gold standard  MRI typically used only to diagnose calcaneal stress fractures in the presence of normal radiographs and/or uncertain diganosis Tests: Other tests that may help your doctor confirm your diagnosis include: X-rays. This test is the most common and widely available diagnostic imaging technique. X-rays create images of dense structures, like bone, so they are particularly useful in showing fractures. Computed tomography (CT) scan. After reviewing your x-rays, your doctor may recommend a CT scan of your foot. This imaging tool combines x-rays with computer technology to
  • 10. produce a more detailed, cross-sectional image of your body. It can provide your doctor with valuable information about the severity of the fracture. Studying CT scans helps your doctor plan your treatment. He or she will often show you the images to help you understand the nature and severity of your injury. HISTORICAL BACK GROUND:  1908 cotton and willson Recommended closed treatment with use of a medially placed sandburg a laterally placed felt pad and a hammer to reduce the lateral wall and “reimpact” pf the fracture  1920 s Abandoned the treatment of acute fractures altogather and had turned instead of healed malunious  1931 bohler Advocated open reduction Technical problems associated with operative treatment Infection, malunion, non-union and possible need for amputation  1935 Conn Delayed primary triple arthrodesis  1943 gallie Subtalar arthrodesis as definitive treatment only for fractures that healed this techniquee became standard for healed malunited calcaneal fracture  1948 palmar Dissastified with both nonoperative and late treatment Described the operativeoperative treatment of acute displaced intra articular calcaneal Standard lateral kocher approach to reduce the joint Holding up the fragment with bone graft
  • 11. He stated that is patient did well and that many returend to work  1952 essex Reported similar findings In the last twenty years  Better anasthesia  Antibiotics  Asif principles of internal fixataion  Computed tomography  Flucoscopy Goog outcomes with use of operative intervention Treatment: In planning your treatment, your doctor will consider several things, including:  The cause of your injury  Your overall health  The severity of your injury  The extent of soft tissue damage Because most calcaneus fractures cause the bone to widen, the goal of treatment is to restore the normal anatomy of the heel. In general, patients whose normal heel anatomy is restored have better overall outcomes. Recreating normal anatomy, however, most often involves surgery. Surgery is associated with a higher risk of complications. Your doctor will discuss the treatment options with you. Surgical Treatment:
  • 12. If the bones have shifted out of place (displaced), you may need surgery. Timing of surgery. If the skin around your fracture has not been broken, your doctor may recommend waiting until swelling has gone down before having surgery. Keeping your leg immobilized and elevated for several days will decrease swelling. It also gives skin that has been stretched a chance to recover. This waiting period before the operation often improves your overall recovery from surgery and decreases your risk of infection. Open fractures, however, expose the fracture site to the environment. They urgently need to be cleansed and require immediate surgery. Early surgery is also often recommended for an avulsion fracture. Although uncommon, a piece of the calcaneus can be pulled off when the Achilles tendon tears away from the bone (avulsion). For this type of fracture, early surgery can decrease the risk of injury to the skin around the Achilles tendon. Surgical procedure: The following procedures are used for various types of calcaneus fractures.  Open reduction and internal fixation. During this operation, the bone fragments are first repositioned (reduced) into
  • 13. their normal alignment. They are held together with special screws or metal plates and screws.  Percutaneous screw fixation. Sometimes, if the bone pieces are large, they can be moved back into place by either pushing or pulling on them without making a large incision. Special screws can be placed through small incisions to hold your bone pieces together. (Left) A displaced fracture of the calcaneus. (Right) The fracture has been reduced and the bones held in place with screws. The typical method of realigning the bone fragments and holding them in place with metal plates and screws. Nonsurgical Treatment: If the pieces of broken bone have not been displaced by the force of the injury, you may not need surgery. Casting or some other form of immobilization may be an option. This will keep the broken ends in proper position while they heal. You will not be able to put any weight on your foot until the bone is completely healed. This may take 6 to 8 weeks, and perhaps longer.
  • 14. Recovery: The recovery period of a calcaneus fracture is an important aspect in determining how well a patient will return to his pre- injury level of activity. Patients will be required to keep weight off of the foot for as long as three months. The other critically important aspect of treatment is controlling swelling, especially in patients who have had surgery. The best ways to control swelling includes elevation. Conclusions: Calcaneal fractures are complex injuries that commonly occur in male patients and that result in substantial morbidity. Recently, there has been an exponential proliferation of CT examinations of trauma patients who have sustained multiple injuries. In addition, dramatic advances have occurred in imaging technology, particularly multi-detector CT and image processing. This combination has resulted in dramatic improvements in the visualization of calcaneal injuries, which in turn has led to improved fracture characterization for the trauma patient References: 1. ↵ HartyM. Anatomic considerations in injuries of the calcaneus. Orthop Clin North Am1973; 4: 179–183. Medline 2. ↵ FitzgibbonsT, McMullen ST, Mormino MA. Fractures and dislocations of the calcaneus. In: Bucholz RW, Heckman JD, eds. Rockwood and Green’s fractures in adults. Philadelphia, Pa: Lippincott Williams & Wilkins, 2001; 2133–2179. 3. ↵ GrayH. Anatomy of the human body. Philadelphia, Pa: Lea & Febiger, 1918; Bartelby.com; 2000. 4. ↵
  • 15. CarrJB. Mechanism and pathoanatomy of the intraarticular calcaneal fracture. Clin Orthop Relat Res1993; 290: 36–40. 5. ↵ BurdeauxBD. Reduction of calcaneal fractures by the McReynolds medial approach technique and its experimental basis. Clin Orthop Relat Res1983; 177: 87– 103. 6. ↵ BuckwalterKA, Rydberg J, Kopecky KK, Crow K, Yang EL. Musculoskeletal imaging with multi-slice CT. AJR Am J Roentgenol2001; 176: 979–986. FREE Full Text 7. ↵ LinsenmaierU, Brunner U, Schoning A, et al. Classification of calcaneal fractures by spiral computed tomography: implications for surgical treatment. Eur Radiol2003; 13: 2315–2322. CrossRefMedline 8. ↵ CarrJB, Hamilton JJ, Bear LS. Experimental intra- articular calcaneal fractures: anatomic basis for a new classification. Foot Ankle1989; 10: 81–87. Medline 9. ↵ EastwoodDM, Phipp L. Intra-articular fractures of the calcaneus: why such controversy? Injury1997; 28: 247– 259. CrossRefMedline