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Trauma > Calcaneal Fractures > Flashcards

Calcaneal Fractures Flashcards

1
Q

What proportion of these fractures are open?

A

17%

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2
Q

What is the aetiology of calcaneal fractures?

A

A fall from a height or RTA

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3
Q

What do you find on clinical presentation?

A

Diffuse pain and tenderness
Ecchymosis
swelling
widened heel- varus defomity

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4
Q

What are the types of calcaneal fractures?

A

EXTRA- ARTICULAR

INTRA-ARTICULAR

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5
Q

Can you describe the types of extra-artocular fractures?

A

ANTERIOR PROCESS fractures
TUBEROSITY BODY fractures
TUBEROSITY AVULSION fractures
SUSTENACULUM fractures

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6
Q

What is mechanism for anterior process fractures and their tx?

A

FORCED PLANTIFLEXION AND INVERSION
MOST CAST/BRACE
ORIF IF DISPLACED >25% AT CC JOINT

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7
Q

What is mechanism for tuberosity body fractures and their tx?

A

AXIAL LOADING
CT USED TO RULE OF INTRA-ART FRACTURE
DISPLACED = ORIF

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8
Q

What is mechanism for tuberosity avulsion fracture fractures and their tx?

A

FORCEFUL ACHILLES TENDON

IF SKIN COMPRISE- EMERGENCY ORIF- PERCUTANEOUS SCREW FIXATION- SUP-POST TO INFERIOR DISTAL

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9
Q

What is mechanism for sustenacular fractures and their tx?

A

HEEL LOADING AND FOOT INVERSION
SURGERY RARELY REQUIRED
ORIF IF DISPLACED

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10
Q

What is classification system for intra-articular fractures?

A

ESSEX LOPRESTI- diff between joint depression fracture and tongue type
SAUNDERS CLASSIFICATION- key one!!

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11
Q

Describe the SAUNDERS classification?

A

Based on INTRA-ARTICULAR FRAGMENTS on CORONAL CT
TYPE 1= NONDISPLACED post facet (regardless of no of fractures)
TYPE 2 = 1 FRACTURE in POST FACET- 2 FRAGMENTS
TYPE 3= 2 FRACTURES in post facet,3 FRAGMENTS
TYPE 4= COMMINUTED, >3 Frac lines but 4+ FRAGMENTS

SUBTYPES a,b,c- where fracture lines are
a= most LATERAL + EASIEST TO FIX
C= most MEDIAL + HARDEST to fix

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12
Q

What xrays would be helpful ? what angles would you look for?

A

AP, Lateral, oblique
Harris-to see tuberosity widen
Broden view- visualise post facet-neutral ankle with int rotation of X-ray 10-40 degrees

ANGLE OF GISSANE- NORMAL 135-140 intersection of anterior process and post facet- increase = flattening post facet
BOHLER ANGLE- NORMAL 20-40- intersection of line superior tuberosity to post facet and ant process to post facet. flattening of post facet decreases angle

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13
Q

What is the tx of a stress calcaneal fracture?

A

Cast nwb 6 wks

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14
Q

What is the tx of a saunders 1,extra articular fracture <1cm or pt comorbdiites?

A

Cast nwb 10-12 wks

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15
Q

What tx would be for a tongue type or extra-articular fracture?

A

CLOSED REDUCTION AND PERCUTANEOUS PINNING

EMERGENCY IF SKIN COMPROMISE

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16
Q

What tx would be for a SAUNDERS type 2-3, or large displaced extra-articular fracture >1cm?
What approach would be used?

A

ORIF
EXTENSILE LATERAL APPROACH - gives access to subtalar and CC joint
ALLOWS for lateral plate placement
HIGH RATE OF WOUND COMPLICATIONS

PIN IN TUBEROSITY- AID REDUCTION
PROVISIONAL FIXATION K WIRES
THEN PLATE
NO BENEFIT To USE OF BONE GRAFT

17
Q

What are the risks of an extensile lateral approach to calcaneum?

A

HIGH RATE OF WOUND COMPLICATIONS- DELAYED WOUND HEALING 25%
FHL RISK- during screw placement LATERAL TO MEDIAL IN sustenaculum tarsi
DEEP INFECTIONS LOWER 1-4%

18
Q

What are the outcomes of surgery dictated by?

A

NO OF INTRA-ARTICULAR FRAGMENTS

QUALITY IF REDUCTION of fragments

19
Q

What are poor outcomes associated with?

A 
AGE >50
OBESITY
SMOKERS
DM
PVD
BILATERAL CALCANEAL FRACTURES
MULTIPLE TRAUMA
MEN > WOMEN
MANUAL LABOURERS
WORKERS COMP
20
Q

What is the tx for Saunders type IV?

A

PRIMARY SUBTALAR ARTHRODESIS

21
Q

What are the complications of calcaneal fractures ?

A

WOUND 10-25% esp DM, smokers, Open fractures
SUBTALAR ARTHRITIS
LAT IMPINGEMENT- PERONEUS irritation
DAMAGE TO FHL- screws lat- medial
COMPARTMENT SYNDROME
MALUNION-> LIMITED dorsiflexion-> BLOCK SUBTALAR ARTHRODESIS

22
Q

How des the saunders classification predict outcome ?

A

PROGNOSIS WORSENS AS THE COMMINUTION OF POST FACET WORSENS

Trauma (16 decks)

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