Calcaneal # + Talar # Flashcards

1
Q

What is most common # tarsal bone?

A
  • Calcaneum
  • From fall from height
  • Then axial loading
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2
Q

Tarsal bones

A
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3
Q

Classification of calcaneum #

A
  • Intra-articular vs extra-articular
  • Intra-articular - involve subtalar joint, Sanders Classification
  • Extra-articular - spare subtalar joint, inc avulsion of calcaneal tuberosity
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4
Q

Sanders classification

A
  • I - non-displaced posterior facet (any number of # lines)
  • Type II - one fracture line in posterior facet (two fragments)
  • III - two fracture lines in posterior facet
  • IV - comminuted with more than 3 fracture lines in posterior facet (4 or more fragments)
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5
Q

Clinical features calcaneal #

A
  • Recent trauma eg fall from height, or RTA
  • Pain and tenderness around calcaneal region
  • Inability to weight bear
  • Swollen, bruised
  • Shortened and widened heal
  • Varus deformity
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6
Q

Examination - what to check for with calcaneal #

A
  • Skin integrity
  • Any tenting or blanching skin needs emergency surgical intervention - risk of open #
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7
Q

Differentials for swollen and painful ankle

A
  • Talar #
  • Ankle #
  • Soft tissue injury
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8
Q

X-ray frinding for calcaneal #

A
  • Need AP, lateral and oblique views
  • Calcaneal shortening
  • Varus tuberosity deformity
  • Decreased Bohlers angle
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9
Q

What is Bohlers angle?

A
  • Angle formed between one line from anterior to middle facet and another line from posterior to middle fact
  • Normally 20-40 degrees
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10
Q

Gold standard imaging calcaneal #

A
  • CT imaging - GOLD STANDARD
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11
Q

Management calcaneal #

A
  • Surgical intervention usually
  • Those with <2mm displacement or near normal Bohlers angle may be conservative
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12
Q

Conservative management calcaneal #

A
  • Reserved for <2mm displacement, near normal Bohlers, non-displaced extra-articular
  • Cast immobilisation and non weight bearing for 10-12 weeks
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13
Q

Surgical intervention for calcaneal #

A
  • Closed reduction with percutaenous pinning - if large but minimally displaced #
  • ORIF if not
  • Any # with skin compromise –> emergency fixation
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14
Q

Complication calcaneal #

A
  • Subtalar arthiritis –> analgesia and physio
  • Can have arthrodesis if required (fusion)
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15
Q

MOI for talar #

A
  • High energy trauma
  • Forced dorsiflexion - hits tibial plafond
  • Mostly occur through talar neck
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16
Q

Risk with talar #

A
  • Extraosseous blood supply mostly
  • Highly suceptible to interruption
  • So risk of AVN after #
17
Q

Presentation of talar #

A
  • High impact trauma
  • Immediate pain and swelling of ankle
  • Clear deformity
  • Unable to weight bear
18
Q

Examination of talar #

A
  • Unable to dorsiflex or plantarflex ankle
  • Check for open #
  • White, tenting skin = threatened
19
Q

X-ray for talar #

A
  • Need AP and lateral view
  • Lateral view in full dorsi and plantarflexion to differentiate between type I and II
  • If complex –> CT
20
Q

Classification of talar #

A
  • Hawkins
21
Q

Hawkins classification of calcaneal #

A
  • I - undisplaced
  • II - subtalar dislocation
  • III - subtalar and tibiotalar dislocation
  • IV - subtalar, tibiotalar and talonavicular dislocation

Higher risk of AVN as higher the class

22
Q

Management talar #

A
  • Dependent on Hawkins classification
  • All undisplaced –> conservative in NWB orthosis
  • Displaced –> immediate reduction and surgical repair afterwards
23
Q

Type I Hawkins #

A
  • Conservative
  • Non weight bearing crutches for 3 months
  • Assess for union and AVN in # clinic
24
Q

Type II to IV Hawkins #

A
  • Attempted closed reduction in A&E
  • Plaster of paris cast
  • Repeat radiographs ensure remains in poisition
  • If not possible –> open reduction OOH
  • Then definitive surgical fixation ASAP with referral to tertiary centre if needed
  • Post op –> EXTENDED non weight bearing period
25
Q

Complications of talar #

A
  • AVN - 17%, most common type II-IV
  • OA secondary to AVN or malunion
  • If severe may need arthrodesis
26
Q

What is Hawkins sign?

A
  • Line of subchondral lucency of talar dome on x-ray
  • Seen 6-8 weeks following injury
  • Indicative or bone resorption indicating sufficient vascularity of talus
  • Suggests low risk of AVN
27
Q
A