Accessibility - 46.32.249.112. Clipboard, Search History, and several other advanced features are temporarily unavailable. Patients/participants: Fifty-six displaced Sanders 2B and 2C tongue-type calcaneus fractures identified from an initial cohort of 1118 . J Foot Ankle Surg. Google Scholar, Greenspan A (2014) Orthopedic imaging: a practical approach: Lippincott Williams & Wilkins, Bohl DD, Ondeck NT, Samuel AM, Diaz-Collado PJ, Nelson SJ, Basques BA, Leslie MP, Grauer JN (2017) Demographics, mechanisms of injury, and concurrent injuries associated with calcaneus fractures: a study of 14 516 patients in the American College of Surgeons National Trauma Data Bank. 8600 Rockville Pike Before doi: 10.1016/j.ajem.2007.04.033. Due to the potential for soft-tissue compromise these injuries can . Accessibility J Clin Imaging Sci. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in An official website of the United States government. Calcaneus Fractures: A Possible Musculoskeletal Emergency. FOIA -, Radiographics. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. The .gov means its official. 2012 Apr;20(4):253-8. doi: 10.5435/JAAOS-20-04-253. 53(3):279281, Janzen DL, Connell DG, Munk PL, Buckley RE, Meek RN, Schechter MT (1992) Intraarticular fractures of the calcaneus: value of CT findings in determining prognosis. Recognition of the imaging findings, accurate interpretation, and timely communication may prevent devastating clinical outcomes including soft tissue coverage procedures and amputation. Preparation. The purpose of this study was to determine the incidence of posterior skin involvement in tongue-type calcaneus fractures and to determine the patient and fracture characteristics that lead to high-risk situations. Orthopedics. FOIA [Long-term results of calcaneal fracture treatment by open reduction and internal fixation using a calcaneal locking compression plate from an extended lateral approach]. They are often superiorly displaced because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex. Clipboard, Search History, and several other advanced features are temporarily unavailable. Accessibility 2022 Mar;23(3):196. doi: 10.3892/etm.2022.11119. . Setting: Epub 2016 Apr 27. Skin compromise complicates a large percentage of these injuries because of the thin layer of soft tissue and superficial nature of the fracture. 2008 Aug;22(7):439-45. doi: 10.1097/BOT.0b013e31817ace7e. Tongue-type fractures make up 25-35% of intra-articular calcaneal fractures [ 10, 11 ]. The pressure of the displaced fragment compromising blood flow to the overlying soft tissues is reflected by the ecchymosis and skin blanching present at the time of presentation. MeSH Foot Ankle Spec 10(5):402410, Article Executive Editors. Epub 2018 Jul 30. fracture line when a longitudinal tongue-type fracture line traverses the lateral calcaneus, characterizing joint depres-sion fractures, and fully delineating intra-articular fracture involvement of the anterior process [5]. sharing sensitive information, make sure youre on a federal PMC Sanders 2B fractures were more likely to be in a position of valgus and adduction than those of 2C fractures. government site. Taha T, Mahmoud K, Attia AK, Mekhaimar MM. 1992 Jun;158(6):1271-4 Imaging interpretation and clinical management of these fractures are discussed. If it is not reduced accurately, weakness from Achilles tendon dysfunction will occur. Computed Tomography for Calcaneal Fractures: Adding Value to the Radiology Report. The normal value for the angle of Gissane is between 120 and 145 - "Intra-articular tongue-type fractures of the calcaneus: anatomy, injury patterns, and an approach to management" Berberian W, Sood A, Karanfilian B, Najarian R, Lin S, Liporace F. J Bone Joint Surg Am. The emergent nature of this entity has received little attention in the radiology literature. Would you like email updates of new search results? 2022 Sep 14;34:282-287. doi: 10.1016/j.jor.2022.09.009. This procedure is used to correct a "tongue-type" fracture of the calcaneus (the heel bone). this may result in a tongue-type calcaneus fracture (or a de- pressedvariant)[20,23](Fig.3).Thetongue-typefracturecan result in superior and posterior displacement of the displaced Intra-articular tongue-type fractures of the calcaneus: anatomy, injury patterns, and an approach to management. Patients/participants: We reviewed cross-sectional imaging and documented the presence of a varus/valgus (coronal plane) or adduction/abduction (axial plane) position of the tongue fragment in relation to the intact posterior facet, with greater than 10 degrees of angulation being diagnostic of displacement. J Orthop Trauma. Careers. government site. PubMed Central Because many calcaneus fractures are splinted initially and immobilized for several weeks until swelling resolves, failure to acutely recognize the potential for posterior skin breakdown may lead to severe soft tissue morbidity. MeSH a Lateral radiograph shows a comminuted calcaneal fracture with a tongue-type component (arrow). Emerg Radiol 12(4):171176, Gilmer PW, Herzenberg J, Frank JL, Silverman P, Martinez S, Goldner JL (1986) Computerized tomographic analysis of acute calcaneal fractures. Treatment included lag screw fixation to maintain the reduction without further soft-tissue trauma. Clipboard, Search History, and several other advanced features are temporarily unavailable. Clin Orthop Relat Res 290:3640, Mitchell MJ, McKinley JC, Robinson CM (2009) The epidemiology of calcaneal fractures. et al. 2021 Nov 9;11:59. doi: 10.25259/JCIS_142_2021. 1998 Sep-Oct;12(7):469-73. doi: 10.1097/00005131-199809000-00007. PMC Fig. Foot Ankle 6(4):184193, Wong-Chung J, O'Longain D, Lynch-Wong M, Julian H (2016) Irreducible tongue-type calcaneal fracture due to interposition of flexor hallucis longus. An official website of the United States government. Clin Orthop Relat Res 290:316, Qiang M, Chen Y, Zhang K, Li H, Dai H (2014) Measurement of three-dimensional morphological characteristics of the calcaneus using CT image post-processing. A reduced Bhler angle is noted (see annotated image below). Although mechanism, displacement, and time to presentation were significantly correlated with posterior skin involvement, the surgeon should be aware of this potential complicating factor in all tongue-type fractures. -, Emerg Radiol. -, AJR Am J Roentgenol. 1975 Nov;57(4):413-21 This requires the emergency physician to understand the radiographic morphology of the fracture as well as the clinical signs of skin compromise. Careers. Google Scholar, Sanders R, Vaupel ZM, Erdogan M, Downes K (2014) Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 years) results in 108 fractures using a prognostic CT classification. Would you like email updates of new search results? Unable to load your collection due to an error, Unable to load your delegates due to an error. J Orthop Trauma. and transmitted securely. This site needs JavaScript to work properly. MeSH Foot Ankle Orthop. Percutaneous Cannulated Screw Fixation vs. Plating With Minimally Invasive Longitudinal Approach After Closed Reduction for Intra-Articular Tongue-Type Calcaneal Fractures: A Retrospective Cohort Study. Secondary soft tissue injury can also occur from pressure of the displaced fracture fragments. The Bohler angle measures 9. Joseph Schatzker. Tongue-type fractures are unusual calcaneal fractures in which the displacement of a bony fragment has the potential to tent the skin of the posterior heel. Bhler angle From the case:Calcaneal fracture - tongue-type Annotated image Loading Stack - https://doi.org/10.1007/s10140-018-1629-4. The Essex-Lopresti classification system was developed in 1952. HHS Vulnerability Disclosure, Help Radiographics 31(1):8192, Essex-Lopresti P (1993) The mechanism, reduction technique, and results in fractures of the os calcis, 1951-52. 2004 Sep;35 Suppl 2:SB55-63. Bhler angle Annotated image Annotated image Lateral (annotated) Reduced Bhler angle is shown in red. A 62-year-old female with tongue-type calcaneal fracture due to minor trauma is presented, which is often associated to high-energy injuries in younger individuals. Tongue-type fractures of the calcaneus lead to variable amounts of displacement of the posterior tuberosity. Please enable it to take advantage of the complete set of features! Eur Rev Med Pharmacol Sci 19(22):42204226, CAS Am J Emerg Med 31(7):1151.e11531151.e1154, Daftary A, Haims AH, Baumgaertner MR (2005) Fractures of the calcaneus: a review with emphasis on CT. Radiographics 25(5):12151226, Gardner MJ, Nork SE, Barei DP, Kramer PA, Sangeorzan BJ, Benirschke SK (2008) Secondary soft tissue compromise in tongue-type calcaneus fractures. Calcaneus Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports 2013 Jan;11(23):70-5. Design: Retrospective cohort. Radiographics. 2008 Feb;26(2):254.e1-4. Federal government websites often end in .gov or .mil. White EA, Skalski MR, Matcuk GR Jr, Heckmann N, Tomasian A, Gross JS, Patel DB. CAS Bethesda, MD 20894, Web Policies Google Scholar, Chhabra N, Sherman SC, Szatkowski JP Tongue-type calcaneus fractures: a threat to skin. Google Scholar, Snoap T, Jaykel M, Williams C, Roberts J (2017) Calcaneus fractures: a possible musculoskeletal emergency. The site is secure. Early recognition by the emergency physician and prompt operative repair prevent further injury and obviate the need for surgical soft tissue coverage or potential amputation. Objective: Epub 2018 Jul 30. J Orthop Case Rep. 2019;9(2):11-14. doi: 10.13107/jocr.2250-0685.1358. 2019 Feb;26(1):67-74. doi: 10.1007/s10140-018-1629-4. volume26,pages 6774 (2019)Cite this article. Most calcaneal fractures (70%-75%) are intraarticular and result from axial loading that produces shear and compression fracture lines. 2010 Mar;24(3):142-7. doi: 10.1097/BOT.0b013e3181b5c0a4. official website and that any information you provide is encrypted 6 A 19-year-old man after a fall from height. Fracture lines can be seen near the Achilles tendon attachment and the posterior facet of the calcaneus (intra-articular). Before Discussion: Tongue-type calcaneal fractures and tuberosity fractures must be triaged appropriately within the first few hours of presentation to prevent skin compromise. The site is secure. Careers. Acta Radiol 51(4):438454, Soeur R, Remy R (1975) Fractures of the calcaneus with displacement of the thalamic portion. This displacement may threaten the posterior soft tissue envelope. Calcaneal fractures account for 60% of all tarsal bone fractures. Displacement of the sustentacular fragment in intra-articular calcaneal fractures. Recognition of the imaging findings, accurate interpretation, and timely communication may prevent devastating clinical outcomes including soft tissue coverage procedures and amputation. This article reviews the anatomy of the calcaneus, as well as the clinical presentation and imaging findings of intra-articular tongue-type fractures. Main outcome measurements: Calcaneal fractures have characteristic appearances based on the mechanism of injury and are divided into two major groups, intraarticular and extraarticular. Ann Plast Surg 52(4):380384, Khai Luen K, Wan Sulaiman WA (2017) Functional outcomes after heel pad reconstruction: a review of 7 cases. Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children. This site needs JavaScript to work properly. PMC 2022 Jan 21;17(1):39. doi: 10.1186/s13018-022-02930-y. 2005 Sep-Oct;25(5):1215-26. doi: 10.1148/rg.255045713. Type V fractures are comminuted fractures with a centrally depressed fragment. The .gov means its official. Acta Chir Orthop Traumatol Cech. Bookshelf Tongue-type fractures are unusual calcaneal fractures that produce an unique and relatively uncommon injury pattern to the bone and soft tissues, due to the separation of the calcaneal tuberosity into superior and inferior fragments. Setting: Cao Y, Xu X, Guo Y, Cui Z, Zhao Y, Gao S, Tian Y, Lv Y, Zhou F. Front Surg. Description of Extreme tongue-type (beak) fracture of the calcaneus body. Intra-articular tongue-type fractures may develop skin breakdown and often require urgent surgical reduction and fixation. eCollection 2021. Please enable it to take advantage of the complete set of features! Discussion: Retrospective cohort. The https:// ensures that you are connecting to the The tongue-type calcaneus fracture most often displaces into a position of plantarflexion, valgus, and adduction. Calcaneal fractures account for 60% of all tarsal bone fractures. type 2c: involves one primary fracture line that courses through the medial aspect of the posterior facet and is accompanied by a transverse fracture through the body of the calcaneus; this fracture is often accompanied by one or more accessory fracture lines that do not involve the posterior articular facet Foot Ankle Clin 12(1):107123, Wang CL, Cheng CK, Chen CW, Lu CM, Hang YS, Liu TK (1995) Contact areas and pressure distributions in the subtalar joint. Conclusion: Open wounds occur with calcaneus fracture from direct application of force and from tearing along the medial side of the fracture as the tuberosity displaces laterally. Fracture lines can be seen near the Achilles tendon attachment and the posterior facet of the calcaneus (intra-articular). AJR Am J Roentgenol. In the axial plane, 98% of tongue pieces were in a position of adduction (64%) or neutral (34%), with an average angulation into adduction of 15.0 degrees. Soft tissue complications following calcaneal fractures. 2006 Oct;20(9):618-22. doi: 10.1097/01.bot.0000249420.30736.91. Emerg Radiol. 2005 Sep-Oct;25(5):1215-26 Clin Orthop Relat Res 30:6466, Article PubMed Overall tongue type calcaneal fractures tend to have a more favourable prognosis when compared to articular depression patterns and perhaps not surprisingly treating these injuries with percutaneous techniques also offers advantage. Six soft tissue coverage procedures and one amputation resulted. Intraarticular fractures of the calcaneus: diagnosis and surgical management. Femino JE, Vaseenon T, Levin DA, Yian EH. Objectives: Open wounds occur with calcaneus fracture from direct application of force and from tearing along the medial side of the fracture as the tuberosity displaces laterally. 2022 Apr 4;9:854210. doi: 10.3389/fsurg.2022.854210. Fractures of the calcaneus: a review with emphasis on CT. Calcaneal fracture maps and their determinants. Patients with posterior skin compromise were less likely to have a fall mechanism (P = 0.001), had significantly greater fracture displacement (P = 0.007), were more likely to smoke (P = 0.039), and were more frequently referred on a delayed basis (P = 0.007). Strauss EJ, Petrucelli G, Bong M, Koval KJ, Egol KA. Rev Bras Ortop. eCollection 2022 Nov-Dec. Cursaru A, Creu B, erban B, Iordache S, Popa M, Smarandache CG, Orban C, Crstoiu C. Exp Ther Med. Federal government websites often end in .gov or .mil. Syros A, Perez J, Hodgens BH, Boden AL, Constantinescu DS, Smith B, Davies JP, Steinlauf S. J Orthop. Soft tissue complications and timing of surgery in patients with a tongue-type displaced intra-articular calcaneal fracture: An international retrospective cohort study. Google Scholar, Walters JL, Gangopadhyay P, Malay DS (2014) Association of calcaneal and spinal fractures. type 2c: involves one primary fracture line that courses through the medial aspect of the posterior facet and is accompanied by a transverse fracture through the body of the calcaneus; this fracture is often accompanied by one or more accessory fracture lines that do not involve the posterior articular facet Occasionally, it is completely extraarticular but deserves the same operative treatment and reduction. CAS 8600 Rockville Pike 2004 Apr;52(4):380-4 and transmitted securely. -. 2017 Jan;52(1):28-33. doi: 10.1016/j.jemermed.2016.07.085. Tongue-type fractures are unusual calcaneal fractures that produce an unique and relatively uncommon injury pattern to the bone and soft tissues, due to the separation of the calcaneal tuberosity into superior and inferior fragments. Fig. Emerg Radiol 26, 6774 (2019). A contemporary review. Foot Ankle Clin. Patient demographics, comorbidities, injury mechanism, fracture displacement, and time to presentation were evaluated. To define the pathoanatomy of the tongue-type calcaneus fracture and assess the appropriateness of percutaneous techniques in addressing all planes of deformity in this injury. Although they are often associated to high-energy injuries in younger individuals, this type of fracture can also occur due to minor trauma. Epub 2016 Sep 19. Unable to load your collection due to an error, Unable to load your delegates due to an error. sharing sensitive information, make sure youre on a federal Ankle radiographs revealed a tongue-type calcaneal fracture. Sanders et al.'s [13] original description of intraarticular calcaneal fracture classification was based on coronal and axial CT cross-sections with the widest undersurface of the posterior facet of the talus (Fig. 2 Normal lateral radiograph of the calcaneus. Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 Years) results in 108 fractures using a prognostic CT classification. The subtalar joint is crucial for normal foot and ankle function. A staged treatment plan for the management of Type II and Type IIIA open calcaneus fractures. (Fig.1).1). Emerg Radiol. Allegra PR, Rivera S, Desai SS, Aiyer A, Kaplan J, Gross CE. Am J Emerg Med 26(2):254 e251, Article Traditionally, tongue-type calcaneal fractures have been treated using screw fixation or tension band wiring. Management of intra-articular fracture of calcaneus by combined percutaneous and minimal internal fixation. Imaging interpretation and clinical management of these fractures are discussed. 2016 Jul 1;39(4):e744-8. Please enable it to take advantage of the complete set of features! Before Computed Tomography for Calcaneal Fractures: Adding Value to the Radiology Report. These injuries require urgent reduction and fixation in order to minimize soft tissue compromise from the pressure of the displaced tuberosity fragment on the posterior heel skin. Gardner MJ, Nork SE, Barei DP, Kramer PA, Sangeorzan BJ, Benirschke SK. Objective: To define the pathoanatomy of the tongue-type calcaneus fracture and assess the appropriateness of percutaneous techniques in addressing all planes of deformity in this injury. 2016 Dec 29;52(1):29-34. doi: 10.1016/j.rboe.2016.05.007. MeSH A high incidence (21%) of posterior skin compromise occurs in tongue-type calcaneus fractures. Learn more about Institutional subscriptions, Stoller DW, Tirman PF, Bredella MA, Beltran S (2004) Diagnostic imaging: orthopaedics: Amirsys Salt Lake City, Eiff MP, Hatch R, Higgins MK (2012) Fracture management for primary care Saunders/Elsevier, Cave EF (1963) 7 fracture of the Os Calcis-the problem in general. J Nepal Health Res Counc. The .gov means its official. Setting: ACS Level I trauma center. The site is secure. Bookshelf J Orthop Trauma 12(7):469473, Benito-Ruiz J, Yoon T, Guisantes-Pintos E, Monner J, Serra-Renom JM (2004) Reconstruction of soft-tissue defects of the heel with local fasciocutaneous flaps. Fifty-six displaced Sanders 2B and 2C tongue-type calcaneus fractures identified from an initial cohort of 1118 calcaneus fractures treated over a 16-year period. Careers. Materials and Methods A total of 77 patients with intra-articular tongue-type calcaneal fractures between September 2015 and July 2019 were included in this study. Cao Y, Xu X, Guo Y, Cui Z, Zhao Y, Gao S, Tian Y, Lv Y, Zhou F. Front Surg. Early recognition by the emergency physician and prompt operative repair prevent further injury and obviate the need for surgical soft tissue coverage or potential amputation. (1998) The Essex-Lopresti reduction for calcaneal fractures revisited. Accessibility Delayed Soft Tissue Necrosis in an Atypical Closed Calcaneal Fracture: A Case Report. Foot Ankle Int 30(3):229238, Johnson PT, Fayad LM, Fishman EK (2006) Sixteen-slice CT with volumetric analysis of foot fractures. HHS Vulnerability Disclosure, Help Open all credits. Bethesda, MD 20894, Web Policies This fracture occurs as a result of the Achilles tendon, which is extremely strong, avulsing a posterior fragment which may be either intra- or extraarticular. Injury. 8600 Rockville Pike Twenty-nine fractures (21%) had some degree of posterior skin compromise at presentation, including 12 with threatened skin, 10 with partial thickness breakdown, and 7 with full thickness breakdown. Bookshelf PubMed 2022 Apr 4;9:854210. doi: 10.3389/fsurg.2022.854210. ACS Level I trauma center. Sinus tarsi approach in high-risk patients with displaced intra-articular calcaneus fractures: A case series. eCollection 2022. The site is secure. De Boer AS, Van Lieshout EMM, Van 't Land F, Misselyn D, Schepers T, Den Hartog D, Verhofstad MHJ. Disclaimer, National Library of Medicine eCollection 2017 Jan-Feb. 2022 Springer Nature Switzerland AG. Ankle radiographs revealed a tongue-type calcaneal fracture. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. 2021 Nov 9;11:59. doi: 10.25259/JCIS_142_2021. Skelet Radiol 45(7):977988, Strauss EJ, Petrucelli G, Bong M, Koval KJ, Egol KA (2006) Blisters associated with lower-extremity fracture: results of a prospective treatment protocol. Feng Y, Yu Y, Shui X, Ying X, Cai L, Hong J. Orthopedics. 8600 Rockville Pike J Emerg Med 52(1):2833, Watson TS (2007) Soft tissue complications following calcaneal fractures. Would you like email updates of new search results? Type II or beak fractures are uncommon. When assessing for displacement and angulation in the coronal plane, 98% of tongue fragments were either in a position of valgus (77%) or neutral (21%), with a mean valgus angulation of 17.3 degrees. Knowledge of this deformity may aid in achieving successful closed reduction when using the Essex-Lopresti maneuver or other less invasive techniques. AJR Am J Roentgenol 158(6):12711274, Rubino R, Valderrabano V, Sutter PM, Regazzoni P (2009) Prognostic value of four classifications of calcaneal fractures. Secondary soft tissue compromise in tongue-type calcaneus fractures. 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 Type I (20%) the fracture line may be through the tuberosity, the sustentaculum tali, or the anterior process of the calcaneus. In selected cases, if the malunited joint is still in good condition, it is preserved by corrective osteotomy. The .gov means its official. Foot 19(4):197200, Article Emerg Radiol 23(4):357363, Golshani A, Zhu L, Cai C, Beckmann NM (2017) Incidence and association of CT findings of ankle tendon injuries in patients presenting with ankle and hindfoot fractures. PubMed doi: 10.3928/01477447-20160421-05. This is a preview of subscription content, access via your institution. Richard Buckley, Andrew Sands. Intra-articular tongue-type fractures of the calcaneus: anatomy, injury patterns, and an approach to management. Part of Springer Nature. Results: and transmitted securely. Calcaneal avulsion fractures: complications from delayed treatment. Federal government websites often end in .gov or .mil. Download Citation | Tongue-Type Calcaneus Fractures | Tongue-type calcaneus fractures present a challenge to orthopedic surgeons. eCollection 2021. Univariate analysis and stepwise multinomial logistic regressions were used to identify significant predictors of posterior soft tissue compromise. Those with threatened posterior skin who were treated emergently with percutaneous reduction did not progress to soft tissue compromise. official website and that any information you provide is encrypted J Orthop Trauma 28(10):551563, Lu B, Liu P, Wang Y, Yuan JB, Tang XM, Wei D et al (2015) Minimally invasive manipulative reduction with poking k-wire fixation in the treatment of various types of calcaneal fractures. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. An 2018 Feb;49(2):425-429. doi: 10.1016/j.injury.2017.12.008. In preparation for the procedure, the patient is positioned and anesthesia is administered. Bookshelf J Biomech 28(3):269279, Sangeorzan BJ, Ananthakrishnan D, Tencer AF (1995) Contact characteristics of the subtalar joint after a simulated calcaneus fracture. Would you like email updates of new search results? Semin Musculoskelet Radiol 14(3):307322, Pierre-Jerome C, Moncayo V, Terk MR (2010) MRI of the Achilles tendon: a comprehensive review of the anatomy, biomechanics, and imaging of overuse tendinopathies. Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Blisters associated with lower-extremity fracture: results of a prospective treatment protocol. Minimally invasive treatment and internal fixation vs. extended lateral approach in calcaneus fractures of thalamic interest. Epub 2022 Jan 5. PubMedGoogle Scholar. A case of a tongue-type calcaneus fracture with a posteromedial dislocation of the calcaneal posterior facet and tuberosity is presented. A reduced Bhler angle is noted (see annotated image below). Sanders R, Vaupel ZM, Erdogan M, Downes K. J Orthop Trauma. J Bone Joint Surg Br 57(4):413421, Badillo K, Pacheco JA, Padua SO, Gomez AA, Colon E, Vidal JA (2011) Multidetector CT evaluation of calcaneal fractures. University level I trauma center. Bilateral fractures of the calcaneus occur approximately 10% of the time. FOIA Results: 10,18 Mehta S, Mirza AJ, Dunbar RP, Barei DP, Benirschke SK. Disclaimer, National Library of Medicine eCollection 2020 Jul. 2021 Feb 15;16:275-280. doi: 10.2147/CIA.S291497. In this work, we aim to present a technique guide for an alternative approach to fixation of these fractures given the high potential for failure with traditional methods. A recent retrospective cohort study by Quirine showed a lower incidence of wound problems and deep infection when . Intra-articular tongue-type fractures may develop skin breakdown and often require urgent surgical reduction and fixation. Before Emergency Radiology The authors declare that they have no conflict of interest. eCollection 2022. This site needs JavaScript to work properly. Patients/participants: Snoap T, Jaykel M, Williams C, Roberts J. J Emerg Med. 2007 Mar;12(1):107-23. doi: 10.1016/j.fcl.2006.12.003. Foot 27:13, Ballard DH, Campbell KJ, Blanton LE, Williams JT, Sangster G, Hollister AM, Simoncini AA (2016) Tendon entrapments and dislocations in ankle and hindfoot fractures: evaluation with multidetector computed tomography. and osteoarticular radiology . J Orthop Trauma 20(9):618622, Tornetta P 3rd. White,George R. Matcuk Jr,Nathanael Heckmann,Anderanik Tomasian,Jordan S. Gross&Dakshesh B. Patel, Palmer College of Chiropractic, West Campus, San Jose, USA, You can also search for this author in doi: 10.1016/j.injury.2004.07.012. HHS Vulnerability Disclosure, Help Intra-articular tongue-type fractures of the calcaneus: anatomy, injury patterns, and an approach to management. 2019 Feb;26(1):67-74. doi: 10.1007/s10140-018-1629-4. Publication types Case Reports MeSH terms Accidental Falls Bone Screws Calcaneus / diagnostic imaging The Treatment of Avulsion Fracture of the Calcaneal Tuberosity: A New Technique of 180-Degree Annular Internal Fixation. Disclaimer, National Library of Medicine Curr Probl Diagn Radiol 36(1):110, Carr JB (1993) Mechanism and pathoanatomy of the intraarticular calcaneal fracture. Bethesda, MD 20894, Web Policies White, E.A., Skalski, M.R., Matcuk, G.R. eCollection 2021. PubMed 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. J Clin Imaging Sci. Type III (20%) are oblique fractures. Minimally-invasive treatment of calcaneal fractures. 2013 Jun 5;95(11):995-1000. doi: 10.2106/JBJS.L.01498. Foot Ankle Surg 22(1):18, Keck School of Medicine, University of Southern California, Los Angeles, USA, Eric A. J Foot Ankle Surg 56(5):11141120, Sharr PJ, Mangupli MM, Winson IG, Buckley RE (2016) Current management options for displaced intra-articular calcaneal fractures: non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. HHS Vulnerability Disclosure, Help This site needs JavaScript to work properly. official website and that any information you provide is encrypted An official website of the United States government. Authors of section Authors. The https:// ensures that you are connecting to the and transmitted securely. Several radiographic features of intra-articular fractures have been shown to correlate with the outcome. Management of calcaneal tuberosity fractures. Those injuries that were associated with posterior, secondary soft tissue breakdown were identified and compared to those without breakdown. The https:// ensures that you are connecting to the The https:// ensures that you are connecting to the Unable to load your collection due to an error, Unable to load your delegates due to an error. J Bone Joint Surg Br. 2020 Jul 28;5(3):2473011420927334. doi: 10.1177/2473011420927334. Tongue Type Calcaneal Fracture - Discussion: - if secondary frx line travels parallel w/ plantar aspect of foot, exiting at posterior border of the calcaneus, tounge frx will develop; - secondary fracture line extends posteriorly from superior part of primary frx line (at crucial angle), creating 1 single posterior, superior, & lateral fragment; This calcaneus fracture is a tongue-type injury and associated with significant soft-tissue compromise. The normal value for Bohler's angle is 20-40. Intervention: This article reviews the anatomy of the calcaneus, as well as the clinical presentation and imaging findings of intra-articular tongue-type fractures. b Sagittal CT shows the fracture extends into the posterior facet with minimal displacement (arrow) - "Intra-articular tongue-type fractures of the calcaneus: anatomy, injury patterns, and an approach to management" White. FOIA Am J Emerg Med. Unable to load your collection due to an error, Unable to load your delegates due to an error. government site. The Essex-Lopresti reduction for calcaneal fractures revisited. Types IV and V(60%) involve the subtalar joint. Calcaneal fracture; Computed tomography; Musculoskeletal; Radiography; Tongue-type fracture; Trauma. sharing sensitive information, make sure youre on a federal Correspondence to Tongue-type calcaneal fractures represent 14% to 20% of all calcaneus fractures. Keywords: 2015 Nov;205(5):1061-7. doi: 10.2214/AJR.14.14190. Disclaimer, National Library of Medicine 8,10 They can occur as an isolated fracture line or as part of a more complex, intra-articular calcaneus fracture pattern. Calcaneal Avulsion Fractures: An Often Forgotten Diagnosis. Ideally, the CT scans are formatted in two planes: the semicoronal or oblique coronal plane, which is perpendicular . Calcaneal fractures account for 60% of all tarsal bone fractures. Objectives: Design: Injury. Please enable it to take advantage of the complete set of features! Intra-articular Calcaneus Fractures: Current Concepts Review. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. Epub 2017 Dec 11. Extreme tongue-type (beak) fracture of the calcaneus body. A joint-preserving osteotomy with axial realignment is a treatment option for malunited tongue-type calcaneal fractures encountered early on, before the development of . J Orthop Trauma 22(7):439445, Hess M, Booth B, Laughlin RT (2008) Calcaneal avulsion fractures: complications from delayed treatment. AJR Am J Roentgenol 208(2):373379, Tresley J, Subhawong TK, Singer AD, Clifford PD (2016) Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination. Journal of foot and ankle research 7(1):19, Article 2006 May;12(4):171-6 All tongue-type calcaneus fractures treated at 1 institution between 2002 and 2007 were identified from a trauma registry. This fracture occurs as a result of the Achilles tendon, which is extremely strong, avulsing a posterior fragment which may be either intra- or extraarticular. PMC J Orthop Trauma. They are often superiorly displaced because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex. Intra-articular tongue-type fractures may develop skin breakdown and often require urgent surgical reduction and fixation. Modification of the sinus tarsi approach for open reduction and plate fixation of intra-articular calcaneus fractures: the limits of proximal extension based upon the vascular anatomy of the lateral calcaneal artery. Percutaneous Cannulated Screw Fixation vs. Plating With Minimally Invasive Longitudinal Approach After Closed Reduction for Intra-Articular Tongue-Type Calcaneal Fractures: A Retrospective Cohort Study. The management of this fracture is distinctly different from other calcaneal fractures, as urgent surgery may be required [ 12 ]. Banerjee R, Chao JC, Taylor R, Siddiqui A. J Am Acad Orthop Surg. 2008 Dec;75(6):457-64. J Orthop Trauma 9(3):251258, Calleja M, Connell DA (2010) The Achilles tendon. Of 954 patients with calcaneal fractures, 139 tongue-type calcaneus fractures in 127 patients formed the study group. Occasionally, it is completely extraarticular but deserves the same operative treatment and reduction. J Orthop Trauma. White EA, Skalski MR, Matcuk GR Jr, Heckmann N, Tomasian A, Gross JS, Patel DB. 1990 Oct;13(10):1091-100. doi: 10.3928/0147-7447-19901001-05. Main outcome measurements: sharing sensitive information, make sure youre on a federal Clipboard, Search History, and several other advanced features are temporarily unavailable. Share. Tongue-type fractures of the calcaneus lead to variable amounts of displacement of the posterior tuberosity. government site. 2014 Oct;28(10):551-63. doi: 10.1097/BOT.0000000000000169. It is primarily based on radiographic findings and distinguishes intraarticular fracture patterns into two types (depending on the exit point of the secondary fracture line): "tongue type" and "joint depression" fractures [ 2] [ Figure 1 ]. Bethesda, MD 20894, Web Policies During this procedure, the surgeon stabilizes the bone with hardware to allow the bone to heal properly. Surgical treatment of intraarticular fractures of the calcaneus: comparison between flat plate and calcaneal plate. Eric A. https://doi.org/10.1007/s10140-018-1629-4, DOI: https://doi.org/10.1007/s10140-018-1629-4. Secondary soft tissue injury can also occur from pressure of the displaced fracture fragments. They are often superiorly displaced. -, Ann Plast Surg. Yu Q, Li Z, Li J, Yu Q, Zhang L, Liu D, Zhang M, Tang P. J Orthop Surg Res. Recognition of the imaging findings, accurate interpretation, and timely communication may prevent devastating clinical outcomes including soft tissue coverage procedures and amputation. Federal government websites often end in .gov or .mil. Clin Interv Aging. Google Scholar, Matherne TH, Tivorsak T, Monu JU (2007) Calcaneal fractures: what the surgeon needs to know. These should be treated with immediate reduction, plantarflexion splinting, and close monitoring. 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