Calcaneum Fracture
Somebody with a history of fall from height or jumping ,sustain this fracture.
Important objective Parameters to look for in X-ray
Bohler's angle and Gissane's angle - Both are reduced.
Reduction in Bohler's angle (N- 25-40 degrees) is suggestive of posterior facet involvement.
https://www.ebmconsult.com/articles/critical-angle-gissane-calcaneus-fractures
https://www.orthobullets.com/trauma/1051/calcaneus-fractures
Management in ER
ATLS Review
R/o associated injuries
R/o open wounds, compartment syndrome of foot
Document NV status of foot
Elevate
Analgesia
What are further investigations you would like to see ?
Broden's view - to visualize anterior surface of posterior foot
AP of foot to see C-C joint
CT -scan - understand fracture configuration
also allows classification using Sander's classification
(based on primary fracture line and secondary fragments in posterior facet )
https://radiopaedia.org/articles/sanders-ct-classification-of-calcaneal-fracture-2?lang=us
How to treat this fracture best ?
Best treatment remains contentious.
Good anatomical reduction of subtalar joint is the key.
Non operative treatment - Extra-articular fractures
Surgery - Displaced intra-articular. posterior facet fractures,
Anterior process fractures with more than 25% involvement of the calcaneocuboid joint,
Displaced fractures of the calcaneal tuberosity,
Fracture-dislocations, and
Select open fractures
complications
Poor wound healing
Infection
Require re-operation
Non-union
Intra-articular fractures long term complications- subtalar arthritis and pain
Extra-articular fractures have better outcome than intra-articular. Outcome remain the same whether treated operatively or non-operatively.
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