Calcaneal Fractures

Question 1

what radiographic angles do you look for on x-ray if you suspect calcaneal fracture?

Answer 1

Bohler’s angle

critical angle of Gissane

Question 2

when position does the heel assume after a fall from height?

Answer 2

varus position; heel will often drop in height and get wider too

Question 3

what is Bohler’s angle?

Answer 3

angle formed by the line drawn from the postero-superior surface of the calcaneus and another line drawn thru the anterior process

Question 4

what is the normal range for Bohler’s angle?

Answer 4

25-40 deg

Question 5

what angle will increase in a calcaneal fracture?

Answer 5

critical angle of Gissane

Question 6

what angle will decrease in a calcaneal fracture? why?

Answer 6

Bohler’s angle - in a calcaneal fx, the posterior facet is driven into the calcaneus, making the angle smaller

Question 7

what is the normal range for critical angle of Gissane?

Answer 7

120-145 deg

Question 8

what is the critical angle of gissane?

Answer 8

angle between a line drawn thru the posterior and middle facet of calcaneus and another lawn drawn thru the middle and anterior facet of calcaneus

Question 9

which calcaneal classification systems are based on CT scans?

Answer 9

Sanders and Hannover classifications

Question 10

which vertebrae is most commonly fractured after a fall from height?

Answer 10

L1

don’t forget to get lumbar spine films in your trauma patient!!

Question 11

what physical exam findings will you see in a patient with suspected calcaneal fracture?

Answer 11

• pain with medial to lateral compression
• edema
• Mondor’s sign
• inability to bear weight

Question 12

what is the name of the clinical sign for ecchymosis medial and plantar on the foot?

Answer 12

Mondor’s sign

Question 13

what extra-articular classification system is used for calcaneal fractures?

Answer 13

Rowe

Question 14

Classify this: avulsion fracture of the tuberosity

Answer 14

Rowe 2b

Question 15

Classify this: body fracture involving the STJ (intra-articular)

Answer 15

Rowe 4

Question 16

Classify this: fracture of the calcaneal tubercle

Answer 16

Rowe 1a

Question 17

Classify this: body fracture not involving the STJ (extra-articular)

Answer 17

Rowe 3

Question 18

Classify this: fracture of sustentaculum tali

Answer 18

Rowe 1b

Question 19

Classify this: beak fx of the tuberosity

Answer 19

Rowe 2a

Question 20

Classify this: fracture of the anterior process of calcaneus

Answer 20

Rowe 1c

Question 21

Classify this: joint depression with comminution (intra-articular)

Answer 21

Rowe 5

Question 22

What is the mechanism of injury of a Rowe 1a?

Answer 22

fall w/ heel inverted or everted –>leads to fx of med/lat tubercle

Question 23

What is the MOI of a Rowe 1b?

Answer 23

fall with twisting on a supinated foot –> fx of sustentaculum tali

Question 24

what structure will be very tender in a Rowe 1b fracture?

Answer 24

FHL

Question 25

What is the MOI of Rowe 1c?

Answer 25

supination and plantarflexion --> fx of anterior process

Question 26

what is the most common type of Rowe 1 fracture?

Answer 26

Rowe 1c

Question 27

what is the mechanism of injury for a Rowe 2a fracture?

Answer 27

direct trauma --> beak fx ( a fracture of the superior portion of tuberosity) but spares achilles tendon insertion

Question 28

what is the MOI of a Rowe 2b fx?

Answer 28

strong pull of achilles tendon --> avulsion fx of tuberosity

Question 29

a Rowe 2b fx may lead to what etiology of hammertoes?

Answer 29

flexor substitution (due to deep posterior group overcompensating for gastroc + soleus due to achilles tendon avulsion)

Question 30

what is the MOI for a Rowe 3?

Answer 30

fall from height w/ heel in varus or valgus --> fx of body without STJ involvement

Question 31

what is the MOI for a Rowe 4?

Answer 31

fall from height with foot plantarflexed --> intra-articular fx of the body

Question 32

what is the MOI for a Rowe 5?

Answer 32

fall form height with foot dorsiflexed --> intra-articular fx with joint depression and comminution

Question 33

which rowe classification system is the same as Essex-lopresti tongue type fracture?

Answer 33

Rowe 4

Question 34

which rowe classifications sytem is teh same as Essex-lopresti joint depression fx?

Answer 34

Rowe 5

Question 35

What is the Essex-Lopresti tongue type fx?

Answer 35

primary fx line (shear fx) which is intra-articular and separates the sustentaculum tali from the lateral body; secondary fx thru teh tuberosity

Question 36

what is the Essex-Lopresti depression type fx?

Answer 36

shear fx that divdies teh calcaneus into 2 parts: sustentaculum tali and tuberosity fragment; *lateral wall blowout*

Question 37

how does the sanders classfication divdide calcaneus fractures?

Answer 37

divided into 4 parts (lateral, central, medial, sustentaculum tali) by fx lines

Question 38

lines A, B, and C are organized how?

Answer 38

lateral to medial

Question 39

Classify this: all nondisplaced intra-articualr fx

Answer 39

Sanders type 1

Question 40

in general,what is sanders type 2?

Answer 40

two part fractures of the posterior facet

Question 41

Classify this: 2 part fracture; primary fx line separates the lateral column from the central.

Answer 41

sanders 2a

Question 42

Classify this: 2 part fracture; primary fx line is central and separates the central column from the medial.

Answer 42

sanders 2b

Question 43

Classify this: 2 part fracture; primary fx line is medial and separates the medial column from the sustentaculum tali.

Answer 43

sanders 2c

Question 44

Classify this: 3 part fracture; two fracture lines separate the posterior facet into lateral, central, and mEdial columns.

Answer 44

sanders 3ab

Question 45

classify this: 3 part fx; two fracture lines separate the posterior facet into lateral column, central/medial and sustentaculum column.

Answer 45

sanders 3ac

Question 46

classify this: 3 part fx; two fracture lines separate the posterior facet into lateral/central column, medial column, and sustentaculum column.

Answer 46

sanders 3bc

Question 47

classify this: 4 part fx with 3 fx lines and is highly comminuted with joint depression

Answer 47

sanders 4