Does internal fixation work? The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2 and ~60% of all tarsal fractures 3. In: StatPearls [Internet]. [6][7]Similarly, a foot depressed against an accelerator, brake or floorboard translates a large amount of force through the calcaneus during high-speedautomobile accidents. Calcaneus Fracture Subdivided into types AB, AC, and BC, depending on the position and location of the fracture lines. 2022 May 29. Although screws are thought to provide greater stability . Twenty-one fractures were included in this series and the authors found that calcaneal length, height, and axial alignment can be restored with an external fixator, Bohler's angle cannot be restored with external fixator and ligamentotaxis alone. 2019 Feb 13; [PubMed PMID: 30759357], Toro G,Langella F,Gison M,Toro G,Moretti A,Toro A,Iolascon G, Stentoplasty of calcaneal fractures: Surgical technique and early outcomes. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Would you like email updates of new search results? Calcaneus fracture commonly occurs during a high-energy eventsuch as a car crash or a fall from a ladderwhen the heel is crushed under the weight of the body. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal . Your doctor may prescribe you pain medication or you can take over-the-counter NSAIDs, such as Ibuprofen and Naproxen. Subdivided into types A, B, and C depending on the medial or lateral location of the fracture line. Injury. Hindfoot Fractures: Injury Patterns and Relevant Imaging Findings. Surgery is necessary for a lot of instances of a Calcaneus Fracture. The provider must also keep in mind that certain fracture morphologies necessitate surgical care and that certain patient groups will do more poorly with surgery. Long-term functional results in this cohort resulted in mild pain and some alterations in activities of daily living. Outcomes with open calcaneal fractures are generally poorer than closed fractures. Fracture to the calcaneus is also known as a Lovers Fracture as historically it occurs when landing from a fall, i.e. American volume. The wound complication rate was 29% in the extensile lateral group with 9% of the total treated cases requiring repeat surgery for those complications. Most extraarticular fractures are treated conservatively with 10-12 weeks of casting (true extra-articular fractures only account for roughly 20% of all calcaneal fractures). Due to the force of the injury, the damage is often extensive and often requires surgery. When surgical management is recommended it is with the goal to restore calcaneal morphology and to restore articular congruency. Splinting, ice and elevation will be helpful in improving tissue quality for later operative intervention. An article by Aldridge et al in 2004 reviewed a case series of open calcaneal fractures and found that despite an increase in complications the quality of life metrics was higher than expected. Bethesda, MD 20894, Web Policies 2. 2002 Oct [PubMed PMID: 12377902], Spierings KE,Min M,Nooijen LE,Swords MP,Schepers T, Managing the open calcaneal fracture: A systematic review. The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. This type of fracture commonly occurs during a high-energy event such as a car crash or a fall from a ladder when the heel is crushed under the weight of the body. Created by. The majority are displaced intraarticular fractures (60 to 75 percent) [ 2 ]. A. Write. [28][29] Studies have shown greater than 70% of patients with calcaneus fractures have additional injuries. Thus, the condition is best managed by an interprofessional team that includes a trauma surgeon, emergency department physician, orthopedic nurses, orthopedic surgeon, internist, and physiotherapist. Calcaneus fractures are rare but potentially debilitating injuries. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone. Usually due to a fall from a height at work or a road traffic incident, calcaneal fractures are often intra-articular and displaced, affecting primarily the subtalar joint. and transmitted securely. The authors had no deep or superficial wound infections requiring surgical intervention, which is promising but the authors simultaneously cautioned against drawing conclusions from such a small and limited series without statistical power or a control group. Traditionally, a burst fracture of the calcaneus was known as "Lovers Fracture" as the injury would occur as a suitor would jump off a lover's balcony (axial loading) to avoid detection. Calcaneal fractures usually occur after a high-energy accident, such as in a motor vehicle crash or a fall from a great height. [14](Level III), Complete recovery from a calcaneus fracture may take months or even years. Many other groups have similar findings in that the sinus tarsi approach seems to lead to similar radiographic and functional outcomes with fewer wound complications overall. These types of stress fractures are often misdiagnosed as Insertional Achilles Tendonitis. Gravity. 2017 Sep-Dec [PubMed PMID: 28844198], Aldridge JM 3rd,Easley M,Nunley JA, Open calcaneal fractures: results of operative treatment. [23], Some authors have adopted a two-stage surgical approach for severely displaced closed calcaneal fractures to try to mitigate the issue of soft tissue compromise. This is not medical advice. [26], The Sanders classification has been found to have sustained prognostic value. The calcaneus is the most commonly fractured tarsal bone, representing 60 percent of all tarsal fractures in adults [ 1 ]. [20]. The Journal of bone and joint surgery. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal/plantar flexion. Please note that narcotics in our practice are extremely restricted and are NOT a good long term solution. . Treating a calcaneal fracture can be extremely tricky, because the fracture is rarely a clean break like you might see in a broken shin or arm. 2018 Mar 9; [PubMed PMID: 29523122], Sop JL,Sop A, Open Fracture Management . 2008 Aug [PubMed PMID: 18670282], Buckley R,Leighton R,Sanders D,Poon J,Coles CP,Stephen D,Paolucci EO, Open reduction and internal fixation compared with ORIF and primary subtalar arthrodesis for treatment of Sanders type IV calcaneal fractures: a randomized multicenter trial. 2019 Apr;36(2):269-277. We recommend a consultation with a medical professional such as James McCormack. We do not capture any email address. Also, many patients will benefit from either custom or over the counter arch supports. NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. government site. Drains are typically removed on postoperative day 2 or even earlier based on surgeon preference. Only 6% of the minimally invasive group had wound complications and none required additional surgery. These injuries are also closely associated with the . The subtalar joint is formed by the calcaneus and the bone above it, which is called the talus. Journal of orthopaedic trauma. Access this article for 1 day for:30 / $37 / 33 (excludes VAT). Nondisplaced Sanders type I fractures may be treated in a conservative, closed fashion. Arthroscopy techniques. Symptoms of a Calcaneus Fracture include pain when weight bearing on the heel that is worse with impact activity such as walking, running or jumping. The peak incidence occurs in younger males [ 2 ]. -, Cottom JM, Douthett SM, McConnell KK. Journal of orthopaedic trauma. The tuberosity fragment may then rotate superiorly. Disclaimer, National Library of Medicine 2004 May-Jun; [PubMed PMID: 15161170], Jimnez-Almonte JH,King JD,Luo TD,Aneja A,Moghadamian E, Classifications in Brief: Sanders Classification of Intraarticular Fractures of the Calcaneus. Some intraarticular injuries may be treated in a closed fashion depending upon severity. A recent randomized controlled trial reviewed operative versus non-operative treatment for closed, displaced, intra-articular calcaneus fractures. It included a total of 151 patients with 73 in the operative arm and 78 in the non-operative arm. Calcaneus fractures are rare but potentially debilitating injuries. There are two main categories of Calcaneus Fracture. The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. A calcaneal fracture occurs when an excessive force crushes the heel bone against the talus (the lowest bone of the ankle). -, Bibbo C, Siddiqui N, Fink J, Powers J, Ehrlich DA, Kovach SJ. Adams MR, Koury KL, Mistry JB, Braaksma W, Hwang JS, Firoozabadi R. Plantar Medial Avulsion Fragment Associated With Tongue-Type Calcaneus Fractures. The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2 and ~60% of all tarsal fractures 3. Fractures: Non-displaced or minimally displaced fragment, 2 bony fragments which are subdivided into A, B or C depending on if they are medial process or lateral process fracture, 3 bony fragments, divided into AB, AC or BC relative to the position and location of fracture lines. All open wounds need immediate surgery. Please note: your email address is provided to the journal, which may use this information for marketing purposes. A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. Similar types of Calcaneus Fractures can occur due to car crashes. Upon removal of the boot, Physical therapy consisting of mobalisations, mobility and strengthening exercises should commence. You may see blisters form. The type of surgery required should be discussed with an orthopaedic consultant. Before Icing. There are two main classification systems of extraarticular fractures. Clinical orthopaedics and related research. [17]. Copyright 2022 BMJ Publishing Group Ltd, North Petherton Surgery: GP Opportunity (up to 8 sessions) - North Petherton Surgery, Meadows Surgery: GP Opportunity (up to 8 sessions) - The Meadows Surgery, Ilminster, Bruton Surgery: GP Opportunity (8 sessions) - Bruton Surgery, Government of Jersey: Staff Grade in Trauma & Orthopaedics, Womens, childrens & adolescents health. Patients must be counseled that there are advantages and disadvantages to surgical treatment. The minimally invasive group's fracture composition was 61% Sanders II and 39% Sanders III. sharing sensitive information, make sure youre on a federal Restoration of normal alignment and contour is considered the . The group demographics were comparable. It allows for adequate visualization intra-operatively and allows for manipulation of the fracture to restore alignment and articular surfaces. 1998; [PubMed PMID: 9801778], Benirschke SK,Sangeorzan BJ, Extensive intraarticular fractures of the foot. Scenario: A 43-year-old man fell off of a ladder from approximately 7 ft high and landed completely on one foot. 2014 Feb 19 [PubMed PMID: 24553887], Ohashi K,Sanghvi T,El-Khoury GY,Ahn JM,Bennett DL,Geijer M,Inaoka T,Berbaum K, Diagnostic accuracy of 3D color volume-rendered CT images for peroneal tendon dislocation in patients with acute calcaneal fractures. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal/plantar flexion. [32] This may result from direct damage to the tendons themselves as a result of the injury or fracture fragments that may impinge on the tendons. 2022 Aug 8. 2019 Apr; [PubMed PMID: 30784532], Herrera-Prez M,Oller-Boix A,Valderrabano V,Gonzlez-Casamayor S,Gutirrez-Morales MJ,Guerra-Ferraz A,Pas-Brito JL, [Calcaneal fractures: controversies and consensus]. Describe the pathophysiology of calcaneus fractures. 1993 Jul; [PubMed PMID: 8519099], Shannon SF,Houdek MT,Wyles CC,Yuan BJ,Cross WW 3rd,Cass JR,Sems SA, Allgwer-Donati Versus Vertical Mattress Suture Technique Impact on Perfusion in Ankle Fracture Surgery: A Randomized Clinical Trial Using Intraoperative Angiography. Medicine. The extensile lateral approach has been the primary approach for many years for operatively treating calcaneal fractures. Skin quality around the heel must be evaluated for tenting and/or threatened skin. The Journal of bone and joint surgery. Injury. You doctor will evaluate your foot for swelling and other signs of a fracture or joint damage. There are several types of fracture patterns that can occur with trauma to the heel bone. Epub 2022 Mar 11. Calcaneal fractures occur on the calcaneus or heel bone, a large bone that forms the foundation of the rear part of the foot. In a head-on collision, it is common for the driver or a passenger to suffer from a broken heel upon impact. Open fractures will most likely present with a laceration or puncture wound on the medial aspect of the foot. Your doctor will examine your heel and foot, and get an x-ray to see if it is broken or not. Weight-bearing is often delayed 8-12 weeks (or more depending on the degree of comminution and progression of healing on radiographs). Many times, surgery is necessary to restore normal anatomy and mobility. Journal of orthopaedic trauma. Normal Bohlers and Gissane angles do not rule out a fracture. A two year recovery, with a stiff, painful, deformed foot that will not fit into a normal shoe and osteoarthritis of the subtalar joint are common outcomes.1, Orthopaedic surgeons often fix these fractures internally to try to improve the final result. The subtalar or calcaneotalar joint accounts for at least some foot and ankle dorsal/plantar flexion. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Please enable it to take advantage of the complete set of features! He offers. This activity reviews the causes, presentation, and diagnosis of calcaneus fractures and highlights the role of the interprofessional team in their management. Unable to load your collection due to an error, Unable to load your delegates due to an error. Care must be taken to ensure one does not over-penetrate the medial cortex. Displaced Type III fractures have a higher likelihood of resulting in subtalar fusion than lower classification injuries and patients should be counseled that further procedures may be required, including possible subtalar fusion. The Journal of the American Academy of Orthopaedic Surgeons. Tarsal fractures account for 2% of all fractures. He presented with constant pain, swelling of the foot and ankle and worsening pain with all ankle/foot movements. After 2 weeks, practice drawing a figure-8 with the toes to increase your range of motion in the ankle. Many are treated with either open surgical reduction and internal fixation, percutaneous pinning, or sometimes arthrodesis. Peroneal tendon instability may result from displaced, intra-articular calcaneus fractures. A clinical assessment by a Physical Therapist can identify the likelihood of a Calcaneus Fracture through clinical tests such as the Calcaneal Squeeze test.If this test is positive for pain, it is likely that you will be referred for an x-ray.If a Calcaneus Fracture is demonstrated on the x-ray, you may be referred for a CT scan for further clarity on the size and . [31]. The calcaneus is one of seven tarsal bones and is part of the hind-foot which includes the calcaneus and the talus. Stress fractures such as those seen in runners would be best evaluated with a bone scan or MRI. Surgical technique. 2010 Mar [PubMed PMID: 20194342], Buckley R,Tough S,McCormack R,Pate G,Leighton R,Petrie D,Galpin R, Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. [30]This is considered post-traumatic arthritis. . This will usually occur five to ten days following the injury. The outlook for recovery depends on how severely the calcaneus was crushed at the time of injury. The varus deformity must also be corrected at this time. A fracture from a fall may require simple strengthening and rehabilitation while a Calcaneus Stress Fracture from running can require a thorough gait analysis and running re-training alongside insoles and changes in footwear. The extensile group's fracture composition was 53% Sanders II and 47% Sanders III. You can download a PDF version for your personal record. [13]. [20]. Patients will present with diffuse pain, edema, and ecchymosis atthe affected fracture site. . [21]Of note, there was no comparison of pre-operative fracture morphology and many authors contend that more severe patterns require the extensile approach and are also predisposed to a higher complication rate. The amount of initial displacement based on Bohler's angle of <0 degrees is correlated with lower functional outcomes. [8]Sanders et all describe that the soft tissue swelling may take up to 21 days to resolve and that surgery should not proceed until this has occurred. The talus acting as a wedge causes depression and the widening of the calcaneal body. PMC CT scan was performed immediately postoperatively and 95% of the fractures have posterior facet reduction to the anatomic position (with no appreciable step-off of the articular surface) and with no reductions >5mm inaccurately reduced. The calcaneus is the most commonly fractured tarsal bone, representing 60 percent of all tarsal fractures in adults [ 1 ]. Often because of the great force needed to break the heel bone, other injuries to the knees and spine are common. Fractures involving the joints (intra-articular fractures) are the most severe calcaneal fractures, and include damage to the cartilage (the connective tissue between two bones). An extraarticular fracture accounts for 25% of all Calcaneus Fractures, while intraarticular fractures account for 75%. STUDY. Discrepancy between the normal angles of . PLAY. A general pain in the heel that gradually worsens could be a sign of a stress fracture. Out of those fractures, 60 percent are classified as a calcaneus fracture. 2020 Mar - Apr [PubMed PMID: 32131003], Kline AJ,Anderson RB,Davis WH,Jones CP,Cohen BE, Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. The Journal of bone and joint surgery. The patient should be adequately educated on the need to elevate the extremity for the first several weeks after surgery to reduce swelling and the subsequent risk of wound complications. One hundred and eight calcaneus fractures operatively treated (Type II and III) were evaluated at a minimum of 10 years with an average follow-up time of 15.22 years. After surgery complications are common and may include compartment syndrome, osteomyelitis, wound infection malunion and subtalar arthritis. Typically, non-surgical treatment involves: Surgical correction of a fractured heel bone is a risky procedure. This site needs JavaScript to work properly. The results of the trial included a higher complication rate including infection and a requirement to remove hardware in 11% of the operative group, but there were no differences between the group with regards to health outcomes, range of motion, heel width, walking speed, and gait. -, Schepers T. Sinus Tarsi Approach with Screws-Only Fixation for Displaced Intra-Articular Calcaneal Fractures. A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. Clin Podiatr Med Surg. These high forces associated with landing from a height directly onto the Calcaneus are often sufficient to create an impact fracture. 2014 Oct; [PubMed PMID: 25243849], Githens M,Shatsky J,Agel J,Bransford RJ,Benirschke SK, Medial external fixation for staged treatment of closed calcaneus fractures: Surgical technique and case series. You should follow the at-home treatments recommended for non-surgical patients, including rest, ice, elevation, and compression. See what our patients have to say. Rehabilitation Protocols for Calcaneus Fractures. [19], The goals of the minimally invasive technique (or sinus tarsi approach) are to minimize soft tissue injury while simultaneously allowing for fracture reduction and stabilization. Type I fractures: 1 nondisplaced or minimally displaced bony fragment. Part II: Open reduction and internal fixation by the extended lateral transcalcaneal approach. In this analysis, there were 2179 participants followed for an average of 22.41 months. Infections and wound breakdown are the most common and devastating complications of the extensile lateral approach. The goal of heel fracture surgery is to restore the shape of the heel bone as close to normal as possible. This type of fracture commonly occurs during a high-energy event such as a car crash or a fall from a ladder when the heel is crushed under the weight of the body. 2013 Jun [PubMed PMID: 23460669], Li LH,Guo YZ,Wang H,Sang QH,Zhang JZ,Liu Z,Sun TS, Less wound complications of a sinus tarsi approach compared to an extended lateral approach for the treatment of displaced intraarticular calcaneal fracture: A randomized clinical trial in 64 patients. Routine serial radiographs should be obtained to ensure the progression of healing. Immobilization with splinting, Bulky Jones type splints are commonly applied. Conservative treatment is most appropriate for simple, non-displaced fracture patterns, especially if they do not involve the joint. The hindfoot articulates with the tibia and fibula creating the ankle joint. 2015 Jul [PubMed PMID: 26111874], Seat A,Seat C, Lateral Extensile Approach Versus Minimal Incision Approach for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fractures: A Meta-analysis. Abnormalities of either of these findings should prompt a CT scan for further classification and evaluation of the fracture. jsandoe. Match. Their cohort of patients additionally had poor quality of life metrics post-operatively. The risk is reduced with a more inferiorly based L-incision. Recent studies suggest regional variation in male/female predominance due to disparities in the types ofregional accident occurrence. official website and that any information you provide is encrypted Combined ipsilateral fractures of talus and calcaneus. Clinical orthopaedics and related research. Non displaced fractures are managed conservatively. All surgical treatment is aimed at restoration of heel height and width (i.e., reconstructing the anatomy to reapproximateBohlerand Gissane angles), repair and realignment of the subtalar joint, and returning the mechanical axis of the hindfoot to functionality. Fracture to the calcaneus is rare, with tarsal bones accounting for approximately 2% of all fractures, while Calcaneus Fractures account for 50-60% of those tarsal fractures. Calcaneus fractures have enormous morbidity and are often associated with many other injuries. Fracture patterns are similar in either mechanism. 2018 Nov 5; [PubMed PMID: 30467055], Zhang Z,Wang Z,Zhang Y,Qiu X,Chen Y, Risk factors for increased postoperative drainage of calcaneal fractures after open reduction and internal fixation: An observational study. Common complications may include: Following surgery, your foot and ankle specialist will likely immobilize your foot in a splint to allow the bone and joints time to heal. Depending on the cause of your injury, your foot and ankle specialist may also examine you for an ankle or mid-foot injury, or refer you to another specialist to check for injuries beyond the foot. Flashcards. 2019 Oct [PubMed PMID: 31921576], Albin SR,Koppenhaver SL,Marcus R,Dibble L,Cornwall M,Fritz JM, Short-Term Effects of Manual Therapy in Patients After Surgical Fixation of Ankle and/or Hindfoot Fracture: A Randomized Clinical Trial. Due to the force of the injury, the damage is often extensive and often requires surgery. [14]. Level 1 evidence supports theAllgwer-Donati stitch's use over the vertical mattress suture in lower extremity trauma as theAllgwer-Donati yields improved tissue perfusion at the incision site. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. This type of fracture commonly occurs during a high-energy eventsuch as a car crash or a fall from a ladderwhen the heel is crushed under the weight of the body. Smokers, elderly patients, and patients with diabetes or vascular disease may be at higher risk for surgical complication, such as an infection or blood loss. When the initial Bohler's angle is greater than fifteen degrees upon presentation their functional results will be better regardless of operative versus non-operative treatment. 2017 Dec [PubMed PMID: 29245290], Sanders R,Vaupel ZM,Erdogan M,Downes K, Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 Years) results in 108 fractures using a prognostic CT classification. Medicine. 2018 May-Jun; [PubMed PMID: 30521710], Diacon AL,Kimmel LA,Hau RC,Gabbe BJ,Edwards ER, Outcomes of midfoot and hindfoot fractures in multitrauma patients. A patient may notice swelling and heat around their heel bone, and there may be subtle bruising on the heel bone. [22]. Calcaneus fracture fixation is associated with high rates of morbidity and disability from wound complications, infection, subtalar arthritis, and malunion. Urgent fracture reduction should proceed at the first sign of skin compromise. When the calcaneus fractures, the hard outer layer can break into multiple irregular fragments and fold in on itself, just like an egg with a broken shell. 2003 Feb [PubMed PMID: 12571499], Eastwood DM,Langkamer VG,Atkins RM, Intra-articular fractures of the calcaneum. Overall the outlook for patients with calcaneus fractures is guarded. We recommend a consultation with a medical professional such as James McCormack. Surgical management of calcaneal fractures. A conservative, non-invasive treatment regimen may also be recommended for patients who are not good candidates for surgery. A temporary reduction may be maintained by the placement of Kirschner wires through this tuberosity fragment into the "constant" fragment of the medial sustentaculum. Please let you doctor know if you are also experiencing any back pain. Patients with a higher initial Bohler's angle. 2020 Jan [PubMed PMID: 28846249], Griffin D,Parsons N,Shaw E,Kulikov Y,Hutchinson C,Thorogood M,Lamb SE, Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. The indication for this approach includes Sanders type II and III, patients with comorbidities that make soft tissue more vulnerable to complications include diabetes mellitus, smoking and/or obesity, peripheral vascular disease, and minimal posterior facet fragment comminution. The three bones of the ankle include: The tibia, or shinbone The fibula, the smaller bone in the lower leg The calcaneus is the most fractured of all tarsal bones. Intra-articular calcaneal with subtalar joint depression. Compression. Immediately post-operatively the patient's foot and ankle should be placed into an extremely well-padded posterior splint. When resting, prop your foot up on stools or pillows to keep it above your heart. The calcaneus connects with the talus and cuboid bones. The force from impacting the ground translates through the lower extremity and upward sometimes causing. The worst results with regards to patient-reported outcomes and complications were found in the Grade III open fractures. Journal of orthopaedic trauma. A calcaneus fracture is a heel bone fracture. Repetitive stress on the Calcaneus bone from activities such as running can cause a Calcaneus Stress Fracture. 2019 Feb; [PubMed PMID: 30664605], Shih JT,Kuo CL,Yeh TT,Shen HC,Pan RY,Wu CC, Modified Essex-Lopresti procedure with percutaneous calcaneoplasty for comminuted intra-articular calcaneal fractures: a retrospective case analysis. Here are some of the causes of a calcaneus fracture. All patients who are candidates for outpatient treatment are non-weight bearing at discharge. Copyright 2015 - 2022 Adam D. Perler, DPM, FACFASSite Design by Swarm Interactive, Heel Bone Fractures (Calcaneal Fractures), Extensive swelling and bruising in the heel region. 2008 Mar;29(3):318-24. doi: 10.3113/FAI.2008.0318. 2015 Feb [PubMed PMID: 24493866], Chu KM,Lui TH, Endoscopic Lateral Calcaneal Ostectomy and Peroneal Tendon Decompression With the Patient in the Prone Position as Management of Subfibular Impingement After Calcaneal Fracture. Typically a small, low-profile is plate is used after reduction of the joint surface and is placed along the joint-line. Usually due to a fall from a height at work or a road traffic incident, calcaneal fractures are often intra-articular and displaced, affecting primarily the subtalar joint. Historically a burst fracture of the calcaneus was coined a "lovers' fracture" as the injury would occur as a suitor jumped off a lover's balcony to avoid detection. Radiographics. Most patients with calcaneus fractures are young, with the 20-39 age group the most common. Overall the outlook for patients with calcaneus fractures is guarded. Explain the importance of improving care coordination among interprofessional team members to improve outcomes for patients affected by calcaneus fracture. American volume. Diagnosis is made radiographically with foot radiographs with CT scan often being required for surgical planning. A thorough evaluation of the entire spine should be performed anytime a calcaneal fracture is identified especially when a fall is a mechanism. Historically a burst fracture of the calcaneus was coined a "Lovers Fracture" as the injury would occur as a suitor would jump off a lover's balcony to avoid detection. A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. Critical Angle of Gissane/Gissane Angle. Spell. This study concluded with recommendations against operative intervention for closed, displaced, intra-articular fractures of the calcaneus. The calcaneus (also called the heel bone) is the largest tarsal bone of the foot. Subtalar osteoarthritis may result from surgical or nonsurgical treatment with an increasing number of patients with non-operatively treated displaced intra-articular calcaneus fractures requiring late subtalar fusion as a result of subtalar arthritis. Normal = 25 -40 degrees; posterior facet/calcaneal tuberosity fx decreases this angle If remains above 15 degrees nonoperative treatment is an option. Copyright 2022, StatPearls Publishing LLC. Calcaneal tuberosity avulsion displaced sustentaculum tali, and large substantial calcaneal body fractures may require operative management. In patients with identifiedthreatened soft tissueupon presentation treated with emergent operative reduction and fixation none went on to further soft-tissue complications[24]. When this occurs, the heel can widen, shorten, and become deformed. Up to a 40% displacement of the peroneal tendons has been appreciated on CT scans of calcaneus fractures. Clinics in podiatric medicine and surgery. Wound Coverage Options for Soft Tissue Defects Following Calcaneal Fracture Management (Operative/Surgical). Calcaneus Fractures: FAQsCauses and Treatment for a Bruised HeelConditions that cause Heel Pain in the Morning, This is not medical advice. [1][2][3]. Journal of orthopaedic trauma. Some surgeons will favor primary subtalar arthrodesis as it seems to reduce the need for subsequent procedures and the associated increased costs and lost time from work associated with those additional surgeries. 2014 Jul 24 [PubMed PMID: 25059747], Wei N,Yuwen P,Liu W,Zhu Y,Chang W,Feng C,Chen W, Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: A meta-analysis of current evidence base. Calcaneus fractures usually hurt and get very swollen right after the injury. American volume. Clin Podiatr Med Surg. Furthermore, all serous and hemorrhagic blisters must be epithelialized. Displaced fractures of the calcaneus, or heel bone, are a serious injury and the outlook for patients, who are typically young, remains poor. Clinical Management of Acute, Closed Displaced Intra-Articular Calcaneal Fractures. Calcaneus Fracture. Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons. If a Calcaneus Fracture is demonstrated on the x-ray, you may be referred for a CT scan for further clarity on the size and location of the fracture. A clinical assessment by a Physical Therapist can identify the likelihood of a Calcaneus Fracture through clinical tests such as the Calcaneal Squeeze test. Process and tubercle fractures of the hindfoot. The meta-analysis did confirm the higher complication rate of operative intervention but concluded that operative treatment of displaced, intra-articular calcaneal fractures has better anatomic recovery, functional outcomes and return to work. Falls. If you have recently experienced a trauma and are experiencing symptoms of a calcaneal fracture, visit your foot and ankle specialist. The fracture lines are opened at this time and may include temporary removal of the lateral wall. An official website of the United States government. Pathology Calcaneal fractures can be divided broadly into two types depending on whether there is articular involvement of the subtalar joint 2,7,8: extra-articular: 25-30% anterior calcaneal process fracture Pathology Calcaneal fractures can be divided broadly into two types depending on whether there is articular involvement of the subtalar joint 2,7,8: extra-articular: 25-30% anterior calcaneal process fracture Sanders Classification: Based on reconstituted CT findings. Calcaneus Fracture Diagnosis. A fall from a ladder or staircase can result in a calcaneus fracture, especially if you land on your heel sideways or firmly flat. Federal government websites often end in .gov or .mil. This occurs when a vertebra in the lower-mid back is crushed. As severe as calcaneal fractures can be, studies have shown that non-surgical treatment can be very nearly as effective as surgical treatment in the right individuals. He reported immediate pain in the foot with inability to bear weight. The calcaneus is the heel bone. Help others by leaving a review of your experience. Elevation of the foot. Acta ortopedica mexicana. Calcaneus fractures are a complex injury. [33]. Since the calcaneus plays . The extensile lateral approach is performed by creating full-thickness soft tissue and periosteal flaps as previously described by Gould and lateral modified by Benirschke and Sangeorzan. A heel bone fracture can be severe, painful and debilitating. However, they are also seen in long-distance runners, ballet dancers and sports involving jumping. -. Alignment is still evaluated under fluoroscopy. FOIA Heel bone fractures are notoriously difficult to treat, and usually require prolonged healing times. Clinics in podiatric medicine and surgery. If not treated emergently skin breakdown may lead to disastrous sequelae. [18][14]. Avulsion fractures require a large amount of twisting or shearing force due to the strength of the ligamentous and tendinous attachments to the calcaneus. Bookshelf Intraoperative Reduction Techniques for Surgical Management of Displaced Intra-Articular Calcaneal Fractures. When this occurs, the heel can widen, shorten, and become deformed. [15]. However, because of the lack of elevation of the L-flap, there is a decreased risk of peroneal tendon irritation and sural nerve complications. This joint is often involved in these types of facture which can lead to long term problems with the joint such as chronic pain, stiffness and the development of arthritis. The operative group was treated as described below with the extensile lateral approach and the non-operative group was treated with initial immobilization followed by gentle mobilization as allowed by pain. Most of the injuries cause the bone to flatten, widen, and shorten. Treasure Island (FL): StatPearls Publishing; 2022 Jan. Sural nerve injury may result in up to 15% of cases treated operatively (more often with the extensile lateral approach). In a linked paper (doi:10.1136/bmj.g4483), Griffin and colleagues report the results of a pragmatic, multicentre, randomised controlled trial comparing operative with non-operative care of closed, displaced intra-articular calcaneal fractures two years after injury.2 They excluded open injuries and grossly displaced fractures, where surgery is absolutely indicated. The broken bone and swelling may cause you to feel throbbing where the bone is broken. BMJ (Clinical research ed.). The epidemiology of tarsal fractures is as follows: Falls from a height directly translate energy into the calcaneus on impact as the heel strikes a surface crushing the calcaneus against the talus. What do they look like - clinically? Heel bones are often injured in a collision where other skeletal parts sustain injury as well. Heel Bone Fractures (Calcaneal Fractures) Rearfoot fractures of either the heel bone (calcaneus) typically occur after a high impact/velocity injury, such as a fall from height or motor vehicle accident. 2005 Dec;13(8):492-502. doi: 10.5435/00124635-200512000-00002. [12], A more recent meta-analysis from 2017composed of 18 trials including 1467 patients found significantly improved anatomical improvements with operative intervention with regards to the restoration of Bohler's angle, calcaneal heights and widths as well as the likelihood of resuming former work. The calcaneus assumes a shortened and widened position with heel varus as a result of the fracture displacement and loss of Bohler's angle. Pain medication. Fractures or breaks of the calcaneus commonly occur after a fall from a height or car accident. The tibial artery and nerve run along the medial aspect of the calcaneal body and are thought to be shielded by the sustentaculum tali thus neurovascular injuries are uncommonwith calcaneal fractures. You should avoid bearing weight on the foot for 10-12 weeks until it is sufficiently healed. Tongue-type fractures can lead to variable amounts of displacement of the tuberosity fragment, but due to the pull of the Achilles tendon, significant superior and dorsal displacement may occur leading to the potential to tent the posterior heel skin and place the soft tissue at significant risk of breakdown. 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