Calcaneal # + Talar # Flashcards
1
Q
What is most common # tarsal bone?
A
- Calcaneum
- From fall from height
- Then axial loading
2
Q
Tarsal bones
A
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
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)
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
6
Q
Examination - what to check for with calcaneal #
A
- Skin integrity
- Any tenting or blanching skin needs emergency surgical intervention - risk of open #
7
Q
Differentials for swollen and painful ankle
A
- Talar #
- Ankle #
- Soft tissue injury
8
Q
X-ray frinding for calcaneal #
A
- Need AP, lateral and oblique views
- Calcaneal shortening
- Varus tuberosity deformity
- Decreased Bohlers angle
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
10
Q
Gold standard imaging calcaneal #
A
- CT imaging - GOLD STANDARD
11
Q
Management calcaneal #
A
- Surgical intervention usually
- Those with <2mm displacement or near normal Bohlers angle may be conservative
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
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
14
Q
Complication calcaneal #
A
- Subtalar arthiritis –> analgesia and physio
- Can have arthrodesis if required (fusion)
15
Q
MOI for talar #
A
- High energy trauma
- Forced dorsiflexion - hits tibial plafond
- Mostly occur through talar neck
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
Complications of talar #
* AVN - 17%, most common type II-IV
* OA secondary to AVN or malunion
* If severe may need arthrodesis
26
What is Hawkins sign?
* 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
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