However, it is still difficult to treat open calcaneal fracture due to the anatomical features of the calcaneus and weak soft tissue coverage on the. The purposes of calcaneal fracture treatment are to restore the normal anatomical relationship of the calcaneus, maintain the stability after reduction, and restore the function of the affected foot to the maximum extent possible. Current controversies in management of calcaneus fractures. A 47yearold male fell from a ladder onto his left lower extremity. For some fractures, nonsurgical treatments may be used. The specific treatment strategy and fixation method for open calcaneal fracture remain to be dis puted.
Mechanism fall from a height in 8090% 10% are associated with lumbar spine fractures fractures are bilateral in 5 10% associated with other lower limb injuries in 25% classification extraarticular do not involve posterior facet 2530% of all os calc. Fractures of the calcaneus heel bone fractures achilles avulsion stress fracture extraarticular fractures tibia talus cuboid calcaneus subtalar. Identify the appearances of intraand extraarticular calcaneal fractures and their treatment implications. The aim of this study is to evaluate the clinical outcome of both. The calcaneus is the bone in the back of the foot, commonly referred to as the heel bone. Due to the tendency for pronatory spasm of the foot, we have often used orthoses post calcaneal fracture to apply a supination moment to the rearfoot in order to increase the stj supination rom. Surgical treatment may involve a need to osteotomize the calcaneus just below the area of nonunion to excise the entire affected area. Healing time of two months or so until the pain has gone away. The calcaneus is the most considerable weightbearing tarsal bone, which makes it vulnerable to injury. In 1843 malgaigne described this fracture and proposed a. A lateral drawing of the classic essexlopresti tonguetype fracture.
Surgical treatment may involve a need to osteotomize the calcaneus just below the. Discuss fracture subtypes associated with open calcaneal fractures. Treatment of calcaneal fracture is still controversial and indication for surgery is not well established. Calcaneal fracture 2020 riverside drive 2 p a g e green bay, wi 54301 9202885555 phase 2 moderate protection phase 812 weeks goals for phase 2 weeks with gradual progression to full weight bearing out of bootminimize effusion. Heel bone calcaneus fractures treatment boston medical. The patient suffered polytrauma including ankle, talar and calcaneal fractures. Excessive axial load in the gissanes angle ga determines a primary fracture line that reaches the neutral triangle area with sparse trabeculae located under the subtalar joint thalamic bone. Such diagnostic studies also help determine the extent of the fractures. An mri can be used to distinguish a calcaneal fracture from plantar fascitis. It is also important to check the range, direction and quality of motion of the stj. All surgical treatment is aimed at restoration of heel height and width i.
Despite the advances in imaging and surgical techniques, management of this fracture is still a challenging task and the outcome of operative treatment remains uncertain1. Treatment treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. Treating a patient with a neglected calcaneal fracture and. Primary subtaler arthrodesis for the treatment of comminuted calcaneal fractures. Calcaneus fracture an overview sciencedirect topics. Heel bone calcaneus fractures treatment boston medical center. Indian population have to be taken into consideration by the orthopedic surgeon to improve the standard of calcaneal.
When this occurs, the heel can widen, shorten, and become deformed. Surgery to repair a calcaneus fracture can restore the normal shape of the bone but is sometimes associated with complications, such as wound. Phase 3 minimum protection phase 1216 weeks goals for phase 3. He was taken to a local hospital and radiographs revealed a leftsided, displaced, intraarticular calcaneus heel bone fracture with a depressed articular segment and he was referred to the hss orthopedic trauma service one day following his injury for definitive treatment. Keywords calcaneus, fracture, surgical treatment 1. Symptoms the most common symptoms of a calcaneus fracture are. Calcaneus fracture repair physical therapy protocol. The tensionband wire is placed from midshaft in the calcaneus to the plantar tubercle of the fourth tarsal bone, dorsal to the tendon of the. The surgeons did not address the calcaneal fracture at that time. Describe secondary treatment options used in the management of this compound fracture. Patient considerations are extremely important when considering the diagnosis of calcaneal fractures.
Healing time of a stress fracture of the calcaneus. This required surgical fixation with a screw to secure the fragment. A physical examination followed by xrays andor ct scans are generally used to diagnosis calcaeneal fractures. Original article treatment of open calcaneal fractures. Medial external fixation for staged treatment of closed. For the past several decades, treatment for calcaneal fractures has been extensively reported on. Calcaneal fracture, plastic reduction forceps, minimally invasive treatment, external fixator. From the fracture surgeons perspective, the calcaneus is a cortical shell surrounded by a fragile softtissue envelope with the articular surfaces supported by an internal network of cancellous. The calcaneus connects with the talus and cuboid bones. Calcaneal fractures account for 23% of all fractures of the body, and 60% of all tarsal fractures. Calcaneal fracture 2020 riverside drive 3 p a g e green bay, wi 54301 9202885555. Aug 30, 2018 a true consensus regarding the management of calcaneus fractures has eluded practitioners for more than 100 years. Calcaneus fracture subtle findings calcaneus fracture using brodens view calcaneus fracture with multiple intraarticular extensions calcaneus fracture ct transverse image calcaneus fracture ct generated 3d image calcaneus fracture mri calcaneus anterior process fracture lateral view calcaneus anterior process fracture oblique. The calcaneus is the most commonly fractured tarsal bone.
The slab fracture on the lateral side of the calcaneus is lagscrewed with a 2. By emil zager, dpm, john grady, dpm, and ibrahim taha, dpm. Introduction descriptions of calcaneal fractures exist since 1839 when compression mechanism causing this type of fracture has been described 1. A true consensus regarding the management of calcaneus fractures has eluded practitioners for more than 100 years. Calcaneus fracture repair physical therapy protocol pg 2 12 weeks progressive wb begins 12 week md visit. If your heel bone calcaneus gets fractured, either due to a traumatic injury or as a result of chronic overuse or repetitive stress, recovery can be.
Fractures of the anterior process represent 1015% of extraarticular injuries. Operative treatment is recommended for displaced intraarticular calcaneal fractures involving the posterior facet with more than 2 mm of displacement, fracturedislocations, and. The specific treatment strategy and fixation method for open. Historically, opinions on the mechanism of injury, the decision to pursue nonoperative management versus surgical intervention, and the resultant disability caused by these fractures have differed. This bone helps support the foot and is important in normal walking motions. Patients admitted with calcaneal fractures from 1st november 2002 till 31st december 2004.
The calcaneus is the most frequently fractured tarsal bone. However, it is still difficult to treat open calcaneal fracture due to the anatomical features of the calcaneus and weak soft tissue coverage on the surface of the calcaneus. Sep 15, 2017 fracture of the calcaneus was the most frequent fracture shown in cadaveric studies. The tensionband wire is placed from midshaft in the calcaneus to the plantar. Nov 08, 2017 operative treatment is recommended for displaced intraarticular calcaneal fractures involving the posterior facet with more than 2 mm of displacement, fracture dislocations, and fractures with. Pain bruising swelling heel deformity inability to put weight on the heel or walk in some minor calcaneus fractures, the pain is not enough to stop you from walking, but you may limp. Treatment should be based on the size of the fragment and extent of injury to the calcaneocuboid joint.
The calcaneus os calcis is the commonest tarsal bone to sustain fracture. The foot and ankle surgeon will discuss with the patient the best treatment whether surgical or nonsurgical for the fracture. He presents to your office with a mechanical block preventing his ankle from dorsiflexing to neutral, continued severe pain and a widened heel. Aug 26, 2012 historical treatment1908, cotton and wilson orif of a calcaneal fracture contraindicated recommended closed treatment with use of a medially placed sandbag, a laterally placed felt pad, and a hammer to reduce the lateral wall and reimpact the fracture. Advocated operative treatment but technical complications s infection, malunion, nonunion, need for. Calcaneal fracture summary high energy injury, look for associated injuries many result in long term morbidity and impairment this can be decreased with operative treatment provided complications avoided patient selection and management of comorbidities is essential for good outcomes. Calcaneus fractures were classified by the essexlopresti system and a joint depression type fracture was considered to have ba less than 20. Increase neuromuscular control tas ks in a safe environment. Displaced intraarticular calcaneal fractures are usually caused by a fall from height with one or both heels directly hitting the ground. Calcaneus fractures 2016 orthopaedic trauma association.
Surgery for fracture of the calcaneus 5 28 year followup of 20 cases a darder prats, a silvestre mutioz, f segura llopis, e baixauli perello and a darder garcia 20 displaced intraarticular fractures of the calcaneus fractures. Xray ankle, subtalar, forefoot, toe aarom gentle stretch and isometrics. In 1843 malgaigne described this fracture and proposed a classification 1. Baumgaertner, md the calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures. Surgeons performed immediate open reduction with internal fixation for a severe depressed talar body fracture and an isolated, displaced medial malleolus fracture. Custom foot orthotics following treatment of calcaneal fracture. Extraarticular fractures account for 30% of all calcaneus fractures in adults.
The ct scan of the calcaneus has brought new difig. The vascularity of the calcaneus makes it less dependent for healing on the compressive. A small, nondisplaced fracture is best treated nonoperatively. Gradual increase in weight bearing in shoe starting at 20lbs. Nonsurgical treatment of some fractures, however, can also lead to longterm complications, such as pain, arthritis, and a limp. Discuss the pathophysiology of calcaneal fractures. In addition,advanced imaging tests are commonly required. Right calcaneus fracture treatment patient history a 50yearold obese male bmi 36 was involved in a motor vehicle collision.
Operative versus nonoperative treatment sanders type iii and iv fractures lack of a statistically significant improvement in functional outcomes with orif risk of wound complication and infection restoration of overall calcaneal shape, alignment and height avoids many sequelae of calcaneal fracture malunion. If the bones have shifted out of place displaced, your doctor may recommend surgery. Treatment often involves surgery to reconstruct the normal anatomy of the heel and restore mobility so that patients can return to normal activity. After 23 weeks the xray will show a thickened white line in the area of the stress fracture as it begins to remodel itself.
The surgeons did not address the calcaneal fracture at. Calcaneal reduction forceps for minimally invasive treatment of. The most common extraarticular fracture is a calcaneal body fracture. Surgical treatment of calcaneal comminuted intrarticular. Fractures of the calcaneus heel bone fractures what is the calcaneus. Fractures of the calcaneus heel bone fractures foot. Restore full strength of ankle and lower extremity precautions. In contrast to the disappointing results after nonoperative treatment and at the beginnings of calcaneal surgery, the outcome is promising nowadays. Fracture of the calcaneus was the most frequent fracture shown in cadaveric studies. Injury to the soft tissue envelop is a direct result of lost calcaneal morphology and presents a significant clinical obstacle. The calcaneus, also called the heel bone, is a large bone that forms the foundation of the rear part of the foot. The connection between the talus and calcaneus forms the subtalar joint.
We are reporting the mid term outcome of calcanel fractures treated conservatively. Currently, external fixators have been mainly used for the treatment of open calcaneal frac. Primary subtalar joint arthrodesis in the treatment of. Identify the ap pearances of intra and extraarticular calcaneal fractures and their treatment implications. Surgery to repair a calcaneus fracture can restore the normal shape of the bone but is sometimes associated with complications, such as wound healing problems, infection, and nerve damage. Historical treatment1908, cotton and wilson orif of a calcaneal fracture contraindicated recommended closed treatment with use of a medially placed sandbag, a laterally placed felt pad, and a hammer to reduce the lateral wall and reimpact the fracture. Open reduction and internal fixation compared with orif and primary subtalar arthrodesis for treatment of sanders type iv calcaneal fractures. The surgeon must consider the patient and the fracture when making decisions about treatment. Treatment of open calcaneal fractures using a new external fixator. Calcaneus fracture repair physical therapy protocol postop nwb on surgical foot elevate aggressively at heart level not above foot in posterior foot splint week 1. Intraarticular fractures have a poorer prognosis than extra articular fractures. Treatment can be either surgical or conservative depending on the radiologic classification of the fracture. Fractures of the calcaneus rsna publications online.
Swelling, blistering, and skin sloughing after calcaneus fractures often preclude early open definitive treatment. The joint on top of the calcaneus is responsible for allowing the foot to rotate inwards and outwards. A total of 410 patients were included in the study, 33 of whom had calcaneus fractures 27 joint depression and 6 isolated impaction of the anterior calcaneus process. Operative treatment contraindicated s recommended closed treatment with a medially placed sandbag and a hammer to to reduce the lateral wall. He sustained multiple injuries, including an unstable fracture of the thoracic spine, pelvic ring disruption, left acetabulum fracture, and right calcaneus fracture. Biomechanics archives january 2005 conservative approach.
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