Archive | July, 2016

Calcaneal Fracture

15 Jul

submitted by Christina Brown, M.D.

 

Definition – Fracture of the calcaneus secondary to fall from significant height. calcaneal_fracture Attributed to shear stress adjoined with compressive forces combined with a rotary direction.  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.

 

Signs and Symptoms

Most common symptoms = pain upon plantar flexion and palpation of heel.  

Other symptoms include: Inability to bear weight, limited mobility. 

“Mondor sign” = Hematoma extending to sole of foot; pathognomonic for calcaneal fracture [3].   

Associations – Vertebral compression fractures occur in approximately 10% of these patients [1].  A trauma-focused clinical approach should be implemented to evaluate for tibial, knee, femur, hip tenderness.

 

Diagnostic Imaging:

Xray’s – Recommended views = Axial, AP, Oblique [1].

CT – Best for visualization of subtalar joint

 

Intraarticular vs Extra articular:

Intraarticular fractures = more common and tends to involve the posterior talar articular facet of the calcaneus. 

  1. Type I – Non-displaced fractures (displacement < 2 mm).
  2. Type II – Single intraarticular fracture that divides the calcaneus into 2 pieces.
  3. Type III – Two intraarticular fractures that divide the calcaneus into 3 articular pieces.
  4. Type IV – More than three intraarticular fractures.

 

Treatment:

Non-surgical treatment is indicated for intraarticular fractures and Sanders Type I intraarticular fractures. 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. 

 

Complications:   Skin blisters may become infected if medical attention is delayed, which can lead to necrotizing fasciitis or osteomyelitis, causing irreparable muscle/bone damage [4].

 

References:

  1. 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. Calcaneus Fractures at eMedicine
  3. Richman, JD; Barre, PS (1986). “The plantar ecchymosis sign in fractures of the calcaneus”. Clinical Orthopaedics and Related Research (207): 122–5.
  4. 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.
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