Calcaneal Fractures Flashcards Preview

Foot and Ankle FRCS > Calcaneal Fractures > Flashcards

Flashcards in Calcaneal Fractures Deck (22):
1

What proportion of these fractures are open?

17%

2

What is the aetiology of calcaneal fractures?

A fall from a height or RTA

3

What do you find on clinical presentation?

Diffuse pain and tenderness
Ecchymosis
swelling
widened heel- varus defomity

4

What are the types of calcaneal fractures?

EXTRA- ARTICULAR
INTRA-ARTICULAR

5

Can you describe the types of extra-artocular fractures?

ANTERIOR PROCESS fractures
TUBEROSITY BODY fractures
TUBEROSITY AVULSION fractures
SUSTENACULUM fractures

6

What is mechanism for anterior process fractures and their tx?

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

7

What is mechanism for tuberosity body fractures and their tx?

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

8

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

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

9

What is mechanism for sustenacular fractures and their tx?

HEEL LOADING AND FOOT INVERSION
SURGERY RARELY REQUIRED
ORIF IF DISPLACED

10

What is classification system for intra-articular fractures?

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

11

Describe the SAUNDERS classification?

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

12

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

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

13

What is the tx of a stress calcaneal fracture?

Cast nwb 6 wks

14

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

Cast nwb 10-12 wks

15

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

CLOSED REDUCTION AND PERCUTANEOUS PINNING
EMERGENCY IF SKIN COMPROMISE

16

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

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

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

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

What are the outcomes of surgery dictated by?

NO OF INTRA-ARTICULAR FRAGMENTS
QUALITY IF REDUCTION of fragments

19

What are poor outcomes associated with?

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

20

What is the tx for Saunders type IV?

PRIMARY SUBTALAR ARTHRODESIS

21

What are the complications of calcaneal fractures ?

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

How des the saunders classification predict outcome ?

PROGNOSIS WORSENS AS THE COMMINUTION OF POST FACET WORSENS