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

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Parts

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 : 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

Extra-articular fracture

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.

This x ray shows a undisplaced extra-articular fracture of the body of calcaneus. Red arrows point to the fracture lines.

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

Essex – lopreti`s 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 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 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 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.

Tuberosity #

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 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 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