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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