fracture calcaneum n.
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Fracture calcaneum. Calcaneus fracture or heel fracture is a very common fracture of the of the foot. Functions : Supports weight of the body Acts as a spring board for locomotion . Bones of the foot . . Parts .

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fracture calcaneum
Fracture calcaneum
  • Calcaneus fracture or heel fracture is a very common fracture of the of the foot.

Functions :

    • Supports weight of the body
    • Acts as a spring board for locomotion
slide5
Extra-articular fractures of the body of calcaneus are caused by a fall from height. These fractures can be
  • undisplaced (hairline) or minimally displaced
  • displaced fractures in which the bone fragment has moved proximally (upwards)
  • comminuted (multiple bone pieces) fractures that result in widening of the bone
two types
Two types :
  • extra-articular or those fractures that do not involve the subtalar and calcaneo-cuboid joints
  • intra-articular or those fractures that involve the subtalar and calcaneo-cuboid joints
  • Extra-articular fractures constitute about 1/4 th of all fractures of calcaneum and they are of the following types :
    • tuberosity
    • sustentaculum tali
    • anterior process
    • medial process
    • body of the calcaneus
slide8
Cont…

Extra-articular fractures : -

  • sustentaculum tali, anterior process, medial process, are caused by injuries that twist the foot.
  • Undisplaced fractures of the sustentaculum tali and anterior process are treated by : -
  • immobilization of the foot in a plaster cast for 6 to 8 weeks.
  • Displaced fractures are treated by surgery.
  • Fractures of the medial process are treated by plaster cast immobilization for 4 to 6 weeks.
slide9
This x ray shows a undisplaced extra-articular fracture of the body of calcaneus. Red arrows point to the fracture lines.
intra articular fractures
Intra-articular fractures
  • are caused by
  • vertical loading force on the calcaneus, such as fall from height.
  • constitute the remaining 3/4 th of calcaneal fractures.
  • Essex-Lopresti classification : -
  • tongue type
  • joint depression type
classification
Classification
  • Classification of intra-articular fractures according to Sanders using CT scanning
  • Type 1 are undisplaced
  • Type 2 are two part or split fractures
  • Type 3 are 3 part or split depression
  • Type 4 are comminuted or having multiple fragments
symptoms
Symptoms
  • severe pain and rapid swelling inability to walk or patient walks on his toes
  • dark reddish discolouration of the sole and skin of the heel due to seepage of blood
  • associated fractures of the back or the other bones of the lower limb may be present
  • Less severe symptoms are seen in extra-articular fractures.
diagnosis
Diagnosis
  • x rays of the foot in different positions : -
  • X rays of the opposite uninjured foot are also taken to compare the change in the Bohler angle
  • CT scans may also be required for classification and better evaluation of the fracture.
fractures of the tuberosity
Fractures of the tuberosity

caused by :-

    • a sudden forceful contraction of the calf muscles.
    • more common in elderly people because of osteoporosis.
  • Undisplaced tuberosity fractures : -
  • treated by plaster cast immobilization for 6 to 8 weeks.
  • Displaced fractures require surgery.
  • If surgery is not done then the calf muscles will become weak and ineffective.
  • After surgery a plaster cast is applied for 6 to 8 weeks.
initial treatment
Initial treatment
  • All calcaneus fractures (extra and intra-articular) includes : -
  • Bed rest
  • Elevation of the foot
  • Use of ice to reduce swelling
  • Anti -inflammatory medication to decrease pain and swelling
treatment
Treatment

According to classification : -

  • In Type 1 and undisplaced type 2 and 3 fractures
    • exercises are started as soon as the swelling decreases and pain allows.
    • The patient is not allowed to walk on his heel for at least 6 weeks.
  • Displaced type 2 and 3 fractures :-
    • are treated by surgery in which the fracture fragments are re-aligned and held with plate and screws.
  • In Type 4 fractures :-
  • Improve the alignment of the fracture by manipulation they are then treated similar to type 1 fractures.
  • In these fractures perfect anatomy can not be restored because of multiple fragments, hence the goal of treatment is to get the patient mobile as quickly as possible
complications
Complications
  • Immediate complications includes : -
  • injury to the skin,
  • nerves and
  • blood vessels by displaced fracture fragments
  • Compartment Syndrome in the foot
  • Late complications includes : -
  • arthritis
  • irritation and pressure over peroneal muscle tendons
  • bone spur (bony growth formed on normal bone ) formation causing heel pain