(OBQ04.261) Distal Femur Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports . Factors associated with poor outcome are:Age (older than 50 years) Smoking Early surgery History of a fallHeavy manual labor Obesity Males Bilateral injury Workmans compensation Peripheral vascular disease. In this episode, we review the high-yield topic of Visceral Blunt Trauma from the Knee & Sports section. This site needs JavaScript to work properly. Calcaneal stress fractures can cause intense pain and make walking more difficult. Peak guides you to the most relevant content based on your learning needs and helps you engage with content more effectively with tools like highlighting and personal notes. Feng Y, Shui X, Wang J, Cai L, Yu Y, Ying X, Kong J, Hong J. BMC Musculoskelet Disord. Calcaneus fractures are common injuries that often lead to chronic pain and long-term disability. Conservative therapy (casting + nonweightbearing)Casting and nonweightbearing for 6 weeks for calcaneal stress fracturesCasting and nonweightbearing for 10-12 weeks if:Small extra-articular fracture (<1 cm) with intact Achilles tendon and <2 mm displacementSanders Type I (nondisplaced)Anterior process fracture involving <25% of calcaneocuboid . Treatment of calcaneal fractures has to be tailored to the individual pathoanatomy. On exam, the location of maximal tenderness is indicated by the white arrow in Figure A. type B: fracture of the mid calcaneus . His tibiotalar motion remains pain-free. This resulted in 590 articles. Fractures of the anterior process of the calcaneus occur following an acute injury to the foot. government site. Automatically create a beautiful, listener-friendly podcast site from your RSS feed. Avulsion fracture of the calcaneus is an emergency. Sinus Tarsi Approach with Screws-Only Fixation for Displaced Intra-Articular Calcaneal Fractures. vertical limb between lateral malleolus and Achilles. This image shows no varus or valgus of the hindfoot. 2013 Dec;25(6):554-68. doi: 10.1007/s00064-013-0246-3. Patient has a simple fracture pattern. Distally, it articulates with the fourth and fifth metatarsals. Intermediate Evaluation and Management. Associated conditionsSpine fractures-10% Compartment syndrome of the foot -10% : if neglected will lead to claw toe due to contracture of the intrinsic flexor muscles. 2016 Jul 15;17:288. doi: 10.1186/s12891-016-1122-8. Copyright 2022 Lineage Medical, Inc. All rights reserved. Complication rate is high. What is the most likely explanation for this deformity? There is a negative Tinel's sign at the tibial nerve. He has completed a course of plantar fascia and Achilles tendon stretching with no significant improvement in his symptoms. There is tenderness with medial and lateral compression of the hindfoot and there is a negative syndesmosis squeeze test. (OBQ07.269) PMC The calcaneus not only provides support as you walk, but also connects your calf muscles to your foot. Xiao J, Xin Z, Fu X, Huang J, Zhang B, Yu H. Comput Math Methods Med. In this episode, we review the high-yield topic of Calcific Tendonitis from the Shoulder & Elbow section. type A fractures: the anterior process of the calcaneus is fractured. Video Description . 4-Peroneal tendon irritation and impingement from the lateral wall. The cuboid makes up the midfoot's contribution to the lateral column of the foot and serves mainly as a lateral column spacer block. Which of the following is not commonly seen following malunion of a conservatively-managed calcaneus fracture? eCollection 2022. A 35-year-old patient sustains a left calcaneus fracture. Because of this calcaneal fractures tend to come with other problems that vary with the extent of the injury. Traditionally, there is a male predominance of injuries due to the industrial nature of the accidents. The heel is tender when squeezed. Decreased hindfoot height and increased calcaneal width, Hindfoot valgus with subfibular impingement, Lateral wall exostosis with peroneal tendon irritation. (SBQ18FA.3) Tethering of the flexor hallucis longus by fracture fragments. 2019 Apr;36(2):211-224. doi: 10.1016/j.cpm.2018.10.004. (OBQ10.19) He obtains good pain relief with a steroid injection into the sinus tarsi. Yu, Sarah M., and Joseph S. Yu. He lands on his feet but experiences severe right foot pain. (SBQ12FA.56) 0; Calcaneal Fracture ORIF with Lateral Approach, Plate Fixation, and Locking Screws. An official website of the United States government. Federal government websites often end in .gov or .mil. (SBQ18FA.5) clean out fracture lines and remove lateral wall. In this episode, we review the high-yield topic of Marfan's Syndrome from the Pediatrics section. Calcaneal spurs can be located at the back of the heel (dorsal heel spur) or under the sole (plantar heel spur). FOIA Open fractures Type VI Highly comminuted May require primary subtalar arthrodesis. What is the most likely etiology of this finding? A 30-year-old manual laborer is forced to jump from a collapsing building. Of the options listed below, what is the most appropriate next step in management? . A 42-year-old female undergoes a subtalar bone block distraction arthrodesis as sequelae of a nonoperatively treated calcaneus fracture ten years prior. HHS Vulnerability Disclosure, Help The extensile approach has delayed wound healing in about 20% of cases. Type III--Three-part fracture of the posterior facet. "Calcaneal avulsion fractures: an often forgotten diagnosis." American Journal of . The primary fracture line divides the calcaneus into two main fragments. What is the most likely etiology of this finding? (OBQ06.126) When this occurs, the heel can widen, shorten, and become . A foot radiograph is shown in Figure A, and an MRI is obtained which is shown in Figures B and C. What is the most likely diagnosis? Use of a lateral extensile approach to the calcaneus, Use of screws in the constant fragment that are too long. What is the most appropriate surgical treatment at this time? Extensile lateral versus sinus tarsi approach for displaced, intra-articular calcaneal fractures: a meta-analysis. Calcaneus Fatigue Fractures. Radiographs show significant loss of calcaneal height and an incongruous subtalar joint. Custom orthotic with arch support and medial wedging. Diagnosis is made radiographically with foot radiographs with CT scan often being required for surgical planning. This classification is useful not only in understanding typical fracture patterns of the calcaneus but also in predicting . The Orthobullets Podcast In this episode, we review the high-yield topic of Calcaneus Fractures from the Trauma section. Cuboid Fracture Orthobullets - 9 images - daily dose cuboid fracture, osteochondral lesions of the talus and occult fractures of the foot and, 2022 Nov 4. doi: 10.1007/s00264-022-05622-8. (OBQ10.208) A 26-year-old male sustains a comminuted, intra-articular calcaneus fracture and subsequently undergoes operative intervention as shown in Figure A. Postoperatively in the recovery room, he presents with an isolated, fixed flexed great toe. Complications1-Wound-related complications are the most common complications (20%). He subsequently develops the post-traumatic condition shown in Figure A. What Is a Calcaneal Fracture? Which of the following patients who sustained a calcaneal fracture will most likely undergo an eventual subtalar fusion? Swelling Tenderness with medial and lateral compression of the hindfoot. Lateral calcaneal branch of the anterior tibial artery, Lateral calcaneal branch of the peroneal artery, Lateral malleolar branch of the peroneal artery, Lateral malleolar branch of the dorsalis pedis artery, Lateral malleolar branch of the anterior tibial artery. Bethesda, MD 20894, Web Policies Tracking tools monitor your progress and help you learn more efficiently by decreasing redundancy in the future. Dr. Ebraheims educational animated video describes fracture of the calcaneus - heel bone. Recent studies suggest regional variation in male/female predominance due to . If operative treatment is chosen, anatomic reconstruction of the calcaneal shape and joint surfaces is mandatory. Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures: a prospective randomized controlled trial. A 42-year-old male sustains the closed injury shown in Figure A. In this episode, we review the high-yield topic of Osteopetrosis from the Pediatrics section. A calcaneal stress fracture is one or more small breaks in your heel bone (calcaneus). Occurs in female runners. He presents to your office with a mechanical block preventing his ankle from dorsiflexing to neutral, continued severe pain and a widened heel. The majority are displaced intraarticular fractures (60 to 75 percent) [ 2 ]. Three months after the injury the patient complains of shoewear problems secondary to clawing of the lesser toes. . Unable to load your collection due to an error, Unable to load your delegates due to an error. The calcaneus is the bone that makes up your heel. Stress fracture of the calcaneus may be misdiagnosed as plantar fasciitis. Your personal learning gps. (OBQ06.272) 2023 Bobby Menges Memorial HSS Limb Reconstruction Course. The primary fracture line is caused by an axial load injury. This type of fracture commonly occurs during a high-energy event such as a car crash or a fall from a ladder when the heel is crushed under the weight of the body. 3-Malunion of the calcaneus. 58. Operative Compared with Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures. (OBQ12.265) Calcaneocuboid joint fractures-60% Bilateral fractures of calcaneus -10% Peroneal tendon subluxation: may be detected on axial CT scan. In the treatment of intra-articular calcaneal fractures, surgical reduction and fixation has been shown to have improved outcomes over nonoperative treatment in all of the following patient groups EXCEPT: (OBQ07.176) Which of the following arteries supplies the surgical flap in the extensile open treatment of the injury shown in Figure A? Copyright 2022 Lineage Medical, Inc. All rights reserved. - Discussion: - frx results from multiple compressive loads in wt-bearing activities; - most often seen in military recruits; - symptoms include pain and swelling on both sides of heel and exquisite tenderness to palpation on the lateral & medial aspects of the heel; - diff dx of heel pain: (main consideration is . Dr. Ebraheim's educational animated video describes fracture of the calcaneus - heel bone. Fragment typically does not move due to its attachment to the Achilles tendon, Fragment has the flexor hallucis longus wrap inferiorly around it, Fragment typically does not move due to its attachment to the navicular, Fragment typically displaces superior and laterally, Fragment has the tibialis posterior wrap inferiorly around it, avulsion injury of the bifurcate ligament, in-situ arthrodesis with preserved calcaneal height, Calcaneal Fracture ORIF with Lateral Approach, Plate Fixation, and Locking Screws, Type in at least one full word to see suggestions list, 2021 Orthopaedic Trauma & Fracture Care: Pushing the Envelope, 29th Orthopaedic Trauma - What We Need to Know in 2017, Panel Discussion Lower Extremity 3 - (NYT #37 - S6-5 - 2017). The patient denies point tenderness at the location of the yellow arrow in Figure A. 90 turn with horizontal limb 3cm above plantar surface of foot. The primary fracture line goes from anterolateral to posteromedial. Occurs more in smokers, diabetics and in patients with open fractures. A squeeze test of the heel is positive. For most of the displaced, intraarticular fractures, this can be achieved by less invasive reduction and fixation via a sinus tarsi approach, which . Joint depression type usually needs open reduction.Some surgeons advocate conservative treatment of the calcaneus.Subtalar distraction arthrodesis plus insertion of a bony block and rigid internal fixationThe lateral calcaneal artery provides blood supply to the lateral flap associated with the calcaneal extensile approach. Calcaneus (Heel Bone) Fractures. Bony Preparation and Reduction. (OBQ12.83) He has difficulty with ambulation and has an antalgic gait. In this episode, we review the high-yield topic of Adductor Strain from the Knee & Sports section. In this episode, we review the high-yield topic of Meniscus from the Knee & Sports section. ORIF The axial view Large "constant" sustentacular fragment. A 27-year-old male sustains closed injuries to his right foot in a motor vehicle collision. All of the following would be indications for a subtalar distraction arthrodesis using a bone graft instead of an in-situ subtalar arthrodesis EXCEPT: Presence of a collapsed subtalar joint from AVN, Presence of full ankle dorsiflexion with no tibiotalar impingement. Plain X-ray imaging. A 42-year-old male sustains the injury seen in figure A. A 19-year-old military recruit complains of 7 weeks of right heel pain. Calcaneus fractures are the most common fractured tarsal bone and are associated with a high degree of morbidity and disability. Foot Ankle Orthop. Orthobullets Team Trauma . Type I-- Nondisplaced/Non-operative treatmentType II--Two-part fracture of the posterior facet. The fracture splits the middle of the posterior facet, and it is displaced. In this episode, we review the high-yield topic of MCL Knee Injuries from the Knee & Sports section. He is otherwise neurovascularly intact. The site is secure. Int Orthop. He denies constitutional symptoms. Surgery decreases the risk of post-traumatic arthritis. (SBQ12FA.1) Calcaneal fractures are better if the patient is a female. Figure 1: Skeleton model showing the location of the calcaneus . Sanders type II & type III calcaneal fractures will benefit from surgery of reduction and fixation. Team Orthobullets (D) Trauma . Copyright 2022 Lineage Medical, Inc. All rights reserved. These fractures often occur because of repetitive, long-term stress on the bone, such as from jogging. Clipboard, Search History, and several other advanced features are temporarily unavailable. For joint depression fracture, wait for swelling to go down before surgery. It's important to see your healthcare provider right away if you have a . Nosewicz T, Knupp M, Barg A, Maas M, Bolliger L, Goslings JC, Hintermann B. This is usually related to the amount of force that was used to cause the . The peak incidence occurs in younger males [ 2 ]. (OBQ07.183) Be aware that the sural nerve is in the vicinity of the surgical area. Medially, it articulates with the navicular nad lateral cuneiform. 2018 Sep 24;13(1):243. doi: 10.1186/s13018-018-0943-6. Fracture mapping of intra-articular calcaneal fractures. Bookshelf He is a nonsmoker. Epub 2013 Dec 6. Your video is converting and might take a while Feel free to come back later to check on it. 2022 Jul 4;7(2):65-70. doi: 10.1515/iss-2022-0010. The most common etiology is a forceful axial load to the hindfoot, frequently occurring during a fall. Physical therapy with Graston techniques to plantar fascia. In this episode, we review the high-yield topic of Legg-Calve-Perthes Disease from the Pediatrics section. What negative sequelae would occur with displacement of this fracture in the characteristic fashion? (SBQ18FA.6) Men do worse with calcaneal fractures than women. Which of the following MRI images (Figures B to F) would you expect to find in this patient? Surgery decreases the risk of post-traumatic arthritis. May be seen as an avulsion fracture of the fibula on x-rays. (OBQ07.211) Fractures of the calcaneus: open reduction and internal fixation from the medial side a 21-year prospective study. A patient sustains a comminuted calcaneus fracture. Calcaneal avulsion fractures need urgent reduction and internal fixation to prevent skin complications. Personalized approach for complex bilateral calcaneal osteomyelitis and defect reconstruction with bilateral abductor digiti minimi flaps. In this episode, we review the high-yield topic of Rectus Femoris Strain from the Knee & Sports section. (OBQ09.73) Purely percutaneous fixation is the treatment of choice for displaced extraarticular fractures and simple intraarticular fractures with adequate control of joint reduction. She has pain throughout the day that worsens with prolonged weight-bearing. identify constant anteromedial fragment and build off of it with kwires. 2022 Aug 2;7(3):24730114221115678. doi: 10.1177/24730114221115678. Boston % TECHNIQUE VIDEO 0 % TECHNIQUE STEPS 0. 2-Open fractures of the calcaneus--May lead to amputation & there is a high risk of infection. Reed LA, Mihas A, Andrews NA, Agarwal A, Wall KC, Spitler CA, Johnson MD. The article abstracts were reviewed, and those that were not involving humans, the management of APC fractures, nor had English translation . A 28 year-old-male presents with the injury pattern seen in Figure A. MeSH Positive squeeze test could mean there is a stress fracture of the calcaneus.Get an MRI if x-ray is negative Will see a fracture in T1 as a linear streak or a band of low signal intensity in the posterior calcaneal tuberosity. Male patient, Sanders Type III fracture, treated with ORIF, Male patient, Sanders Type II fracture, treated with ORIF and bone graft, Female patient, workers compensation, Sanders Type I fracture, treated non-operatively, Female patient, Sanders Type II fracture, treated non-operatively, Female patient, workers compensation, Sanders Type II fracture, treated with ORIF. In this episode, we review the high-yield topic of THA Vascular Injury & Bleeding from the Pediatrics section. A 47-year-old male sustained a comminuted calcaneus fracture in a motorcyle accident. Grigorescu O, Dragu A, Bnke F, Schreiber M, Rammelt S. Innov Surg Sci. A Prospective, Randomized, Controlled Multicenter Trial. On examination, his body mass index is 22, he has a normal foot posture and can perform a single leg heel rise without difficulty. Calcaneus Fractures Pathway Updated: 10/9/2017. Fractures of the tuberosity are either from an avulsion or shear-compression mechanism of injury, with the latter constituting most fractures. Calcaneus fractures in children younger than 10 years of age, are usually extra-articular. Accessibility official website and that any information you provide is encrypted (OBQ11.116) 2022 Sep 29;22(1):170. doi: 10.1186/s12880-022-00898-z. Evaluation. The terms used for searching were; 'anterior calcaneus', 'fracture', 'anterior process', 'calcaneus', 'fracture' and 'management of' in human studies. This procedure improves which of the following issues? Axial and lateral radiographs are shown in Figures A and B. Epub 2019 Jan 24. (OBQ10.208) Calcaneal avulsion fracture is an important topic. Fractures of the calcaneus could be open or closed. A. Treatment of Fracture of the Calcaneus via Bone Axial X-Ray Image-Based Minimally Invasive Approach. TECHNIQUE STEPS Preoperative Patient Care. Older children are more likely to have intra-articular . Calcaneal fractures can be divided broadly into two types depending on whether there is articular involvement of the subtalar joint 2,7,8: The calcaneus is also a common site of stress fractures, occurring in the posterosuperior aspect. (OBQ10.208) A 26-year-old male sustains a comminuted, intra-articular calcaneus fracture and subsequently undergoes operative intervention as shown in Figure A. Postoperatively in the recovery room, he presents with an isolated, fixed flexed great toe. T2 will find an increased signal. Calcaneus FX Other Trauma Topics Updated: 9/17/2021. This allows you to push off as you take a step forward. Arthroscopic debridement of the subtalar joint and subfibular recess with in situ subtalar joint arthrodesis, Distraction bone block subtalar arthrodesis, Corrective intra-articular osteotomy of the calcaneus, Arthroscopic debridement of the subtalar joint and subfibular recess with lateral distraction opening wedge calcaneal osteotomy. Proximally, the cuboid has a saddle shaped articulation with the calcaneus. Would you like email updates of new search results? Decreased risk of development of clinically significant subtalar arthritis, Decreased long-term subjective and functional outcomes, Greater difficulty with shoe wear but increased likelihood of returning to work post-operatively, Worse radiographic indices at long-term follow-up. Before Man with calcaneal fracture:Workmans compensation Heavy labor 0-degree Bohler angle: measured on lateral x-ray (Harris view and axial view)Probably will need subtalar fusion.Bohler angle is formed by a line drawn from the highest point of the anterior process of the calcaneus to the highest point of the posterior facet and a line drawn tangential to the superior edge of the tuberosity. The https:// ensures that you are connecting to the For most of the displaced, intraarticular fractures, this can be achieved by less invasive reduction and fixation via a sinus tarsi approach, which may be extended along the "lateral utility" line for calcaneocuboid joint involvement or calcaneal fracture-dislocations. Online ahead of print. Young females less than 40 years of age. The calcaneus is the most commonly fractured tarsal bone, representing 60 percent of all tarsal fractures in adults [ 1 ]. Team Orthobullets (D) MD. A 55-year-old male sustained a Sanders IV intra-articular calcaneus fracture two years ago that was treated nonoperatively. In this episode, we review the high-yield topic of Lateral Patellar Compression Syndrome from the Knee & Sports section. lateral approach to calcaneus with extensile L-shaped incision. sharing sensitive information, make sure youre on a federal Normal is 95-105 degrees. Diagnosis is made radiographically with foot radiographs with CT scan often being required for surgical planning. Up to half of patients with calcaneus fractures have concomitant injuries including compression fractures of thoracolumbar spine [1] 8600 Rockville Pike When considering surgery, which of the following is the only undisputed difference when comparing nonoperative management of this injury to open reduction and internal fixation? Decreased Boehler's angle (<25') may be only sign of fracture (compare with opposite side) Harris view to tuberosity. Keywords: . A 36-year-old male sustains the closed injury shown in Figure A after falling from a ladder. A decrease in this angle indicates the collapse of the posterior facet. (OBQ08.76) Figure A is a radiograph of a healthy, independent 51-year-old male. Complication Rates Are Similar Between Patients Aged <50 and >50 Years in Calcaneus Fractures Treated With the Sinus Tarsi Approach. Open fractures can be a big problem. Non-contrast CT. A calcaneal spur, or commonly known as a heel spur, occurs when a bony outgrowth forms on the heel bone. Talus is attached to constant fragment. Appropriate initial management of calcaneal fractures involves assessment for concomitant trauma (polytrauma), and the vertebral column, in particular, the lumbar spine, is known to be especially vulnerable to simultaneous injury when the os calcis has been fractured. The calcaneus, or heel bone, is a complex shaped bone located just below your ankle and extending to the back of your foot. Intra-articular fractures of the calcaneus. Sun JN, Zhu AX, Shi C, Zhang B, Tang GS, Wang DG, Bing W. BMC Med Imaging. Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. A lateral foot radiograph is shown Figure A. Which of the following is a risk factor for wound complications following operative treatment? He is treated with immediate open reduction internal fixation to prevent which of the following complications? In this episode, we review the high-yield topic of Subacromial Impingement from the Shoulder & Elbow section. Fractures of the calcaneus could be open or closed. Calcaneus fractures are the most common fractured tarsal bone and are associated with a high degree of morbidity and disability. Tarsal fractures account for 2% of all fractures. 60-75% of injuries are intra-articular fractures, no significant increase in infection rates, peak incidence in women in seventh decade of life, violent contaction of the triceps surae with forced dorsiflexion, strong concentric contaction of the triceps surae with knee in full extension, intrinsic tightness of the gastrocnemius and achilles tendon, peripheral neuropathy leading to decreased pain sensation and proprioception resulting in recurrent microtrauma, increased physical activity in the setting of relative energy deficiency, primary fracture line results from oblique shear and leads to the following, includes the sustentaculum tali and is stabilized by strong ligamentous and capsular attachments, dictate whether there is joint depression or tongue-type fracture, strong contraction of gastrocnemius-soleus with concomitant avulsion at its insertion site on calcaneus, more common in osteopenic/osteoporotic bone, inversion and plantar flexion of the foot cause avulsion of the bifurcate ligament, superolateral fragment contains the articular facets, superior articular surface contains three facets that articulate with the talus, the flexor hallucis longus tendon is medial to the posterior facet and inferior to the medial facet and can be injured with errant drills/screws that are too long, between the middle and posterior facets lies the, projects medially and supports the neck of talus, connects the dorsal aspect of the anterior process to the cuboid and navicular, calcaneal tuberosity (Achilles tendon avulsion), the primary fracture line runs obliquely through the posterior facet forming two fragments, the secondary fracture line runs in one of two planes, the axial plane beneath the facet exiting posteriorly in, when the superolateral fragment and posterior facet remain attached to the tuberosity posteriorly, behind the posterior facet in joint depression fractures, based on the number of articular fragments seen on the coronal CT image at the widest point of the posterior facet, One fracture line in the posterior facet (, Two fracture lines in the posterior facet (, based on fracture morphology of the calcaneus tuberosity, tenting, ecchymosis, or lack of skin blanching with tuberosity fractures, neccessitates urgent sugical reduction and fixation to avoid posterior heel skin necrosis, must be debrided and epithelialized prior to surgical intervention, lack of heel cord continuity in avulsion fractures, lack of posterior heel skin blanching with tenting fractures, assess for compartment syndrome secondary to swelling, presence of Langer's lines and skin wrinkles suggests skin is appropriate for surgical intervention, decreased ankle plantarflexion strength with avulsion fractures, assess for neuologic compromise due to swelling, severe peripheral vascular disease may preclude surgical treatment due to poor wound healing potential, useful for evaluation of intraoperative reduction of posterior facet, with ankle in neutral dorsiflexion and ~45 degrees internal rotation, take x-rays at 40, 30, 20, and 10 degrees cephalad from neutral, visualizes tuberosity fragment widening, shortening, and varus positioning, place the foot in maximal dorsiflexion and angle the x-ray beam 45 degrees, demonstrates lateral wall extrusion causing fibular impingement, indicates partial separation of facet from sustentaculum, angle between line from highest point of anterior process to highest point of posterior facet + line tangential to superior edge of tuberosity, represents collapse of the posterior facet, angle between line along lateral margin of posterior facet + line anterior to beak of calcaneus, demonstrates posterior and middle facet displacement, demonstrates calcaneocuboid joint involvement, used only to diagnose calcaneal stress fractures in the presence of normal radiographs and/or uncertain diagnosis, cast immobilization with nonweightbearing for 10 to 12 weeks, anterior process fracture involving <25% of calcaneocuboid joint, comorbidities that preclude good surgical outcome (smoker, diabetes, PVD), avoids the high wound complications seen with these fractures, minimally displaced tuberosity fractures (<1 cm of displacement) without threatened soft-tissue envelope in elderly patients with reduced function or physical capacity, begin early range of motion exercises once swelling allows, early reduction prevents skin sloughing and need for subsequent flap coverage, ideal in patients with sever peripheral vascular disease or severe soft-tissue compromise, lag screws from posterior superior tuberosity directed inferior and distal, require urgent reduction and fixation to avoid skin necrosis (disastrous consequence), open reduction allows for sufficient debridement of contaminated tissue, inability to participate in closed treatment, large extra-articular > 2 mm displacement, posterior facet displacement >2 to 3 mm, flattening of Bohler angle, or varus malalignment of the tuberosity, anterior process fracture with >25% involvement of calcaneocuboid joint, wait 10-14 days until swelling and blisters resolve and wrinkle sign present 10-14 days, no benefit to early surgery due to significant soft tissue swelling, displaced tuberosity fractures with posterior skin compromise should be addressed urgently, number of intra-articular fragments and the, surgical treatment decreases the risk of post-traumatic arthritis, age > 50 (similar outcomes with surgical and nonsurgical treatment), initial Bhler's angle <0 (these injuries do poorly regardless of treatment), lower Bhler angles suggest greater energy absorbed, open fractures (significant soft tissue injury and engery absorbed), bilateral calcaneal fractures (significant gait problems following bilateral injuries), factors associated with most likely need for a secondary subtalar fusion, male worker's compensation patient who participates in heavy labor work with an initial Bhler angle less than 0 degrees, standard short-leg cast for calcaneal stress fractures, standard short-leg cast applied with mild equinus, windowed over posterior heel to allow for frequent skin checks, requires close follow-up to determine if pull of gastrocnemius-soleus dispaces fracture, weekly cast changes are necessary due to high incidence of skin complications, high incidence of vascular insufficiency and diabetes in this population, ideal for poor soft tissue coverage or patients with peripheral vascular disease, Steinmann pin placed into the fracture site anteromedially-to-posterolateral to leverage fragments into place, additional K-wires and Steinmann pins are placed from posterior-to-anterior and lateral-to-medial to secure remaining bone fragments, calcaneal transfixin pin can be used to distract fracture, percutaneus tamps and elevators can be used to raise the articular surface, pins are cut flush with the skin and removed 8-10 weeks post-op, can be combined with distracting external fixator, pins placed in calcaneal tuberosity, cuboid, and distal tibia, restor calcaneal height, width, and alignment, can be combined with percutaneous cannulated screws, extensile lateral L-shaped incision is most popular, vertical portion inbetween posterio fibula and achilles tendon, horizontal portion in line with 5th metatarsal base, a more inferior incision protects the sural nerve, provides access to the calcaneocuboid and subtalar joints, full-thickness skin, soft tissue, and periosteal flaps are developed, lateral calcaneal branch of peroneal artery, superior flap contains the calcaneofibular ligaments and peroneal tendon sheath, sural nerve and peroneal tendons are retracted superiorly, fracture opened and medial wall reduced going medial to lateral, reduction confirmed indirectly via fluoroscopy, tuberosity reduction is done under direct visualization, manual traction, Schanz pins, and minidistractors, height and length of tuberosity is recreated, definitive fixation with plates and screws, restore Bhler's angle and calcaneal height, minimally invasive incision that minimizes soft tissue dissesction, reduces wound complications associated with extensile lateral incision, allows direct visualization of the posterior facet, anterolateral fragment, and lateral wall, same incision can be utilized for secondary subtalar arthrodesis or peroneal tendon debridement, patient placed in lateral decubitus position, incision made in line with the tip of the fibula and the base of the 4th metatarsal, extensor digitorum brevis retracted cephalad to expose sinus tarsi and posterior facet, Schanz pin inserted percutaneously in posteroinferior tuberosity going from lateral to medial, provides distraction and aids with reduction, fibrous debris and fat removed from sinus tarsi, small elevator or lamina spreader placed under posterior facet fragment to aid in reduction, K-wires inserted for provisional fixation aimed towards the sustentaculum, two screw are placed lateral-to-medial to engage sustentaculum and support facet, one large fully threaded screw from posterior-to-anterior to support axial length of calcaneus, low-profile plate is applied underneath a well developed soft tissue envelope with screws engaging anterolateral and tuberosity fragments, nonweight bearing for 6-8 weeks post-op with ankle range-of-motion exercises beginning 2 weeks post-op, manipulate the heel to increase the calcaneal varus deformity, manipulate the heel to correct the varus deformity with a valgus reduction, stabilize the reduction with percutaneous K-wires or open fixation as described above, arthroscopic-assisted reduction and internal fixation, improved visualization of articular surface and carilage lesions, increased swelling from fluid extravasation, can be combined with sinus tarsi approach, patient positioned in lateral decubitus position, fluoroscopy unit positioned posterior and oblique to patient, anterolateral and posterolateral portals are used to visualize posterior facet, loose bodies and cartilage fragments are removed with a shaver, Freer elevator is introduced into one of the portal sites and used to elevate the posterior facet, Schanz pin to control tuberosity fragment, cannulated screws from the posterior aspect of the calcaneal tuberosity to the anterior aspect of the calcaneus, lateral-to-medial screws placed in sustentaculum, buttress screw from the posterior aspect of the calcaneal tuberosity to the subchondral bone of the posterior facet, posterior approach for calcaneal tuberosity fractures, fracture fragment is mobilized and debrided, plantar flexion of foot aids with reduction, presence of gastrocnemius tightness may preclude reduction, Strayer procedure may be performed to aid in reduction, figure-of-8 tension-band wire passed around ends of K-wires or cannulated screws, Krackow sutures passing through bone tunnels, restricted weight bearing for 6 weeks followed by progression of weight bearing an additional 6 weeks, performed in highly comminuted Sanders IV intraarticular fractures, high rate of secondary fusion after ORIF with these injuries, avoids added treatment costs and decreases time off from work, can be performed through an extensile lateral or sinus tarsi approach, fracture reduction is perfromed in a similar fashion as ORIF, articular cartilage of the subtalar joint denuded to bleeding subchondral bone, cannulated compression screws are placed from the posterio calcaneal tuberosity to the talar dome, lateral fixation plate applied to hold reduction, increased risk in smokers, diabetics, and open injuries, may consider nonoperative treatment in these patients, tongue type fractures at high risk (>20%) for posterior skin necrosis, should be splinted in 30 degrees of planarflexion to relieve soft tissue tension, keep all hardware away from the corner of the incision, delayed wound healing is the most common complication, can be addressed with ankle bracing (gauntlet type), NSAIDs, injections, and physical therapy, may require bone block subtalar arthrodesis to address loss of calcaneal height, important when there are symptoms of anterior ankle impingement, Lateral impingement with peroneal irritation, at risk with placement of lateral to medial screws, especially at level of sustentaculum tali (constant fragment), loss of height, widening, and lateral impingement, distraction bone block subtalar arthrodesis, incongruous subtalar joint/post-traumatic DJD, results from posterior talar collapse into the posterior calcaneus, Lateral exostosis with no subtalar arthritis, Lateral exostosis with subtalar arthritis, Lateral exostosis, subtalar arthritis, and varus malunion, increased due to mechanism (fall from height), smoking, and early surgery, lateral soft tissue trauma increases the rate of complication, Adult Knee Trauma Radiographic Evaluation, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries. Male worker's compensation patient who participates in heavy labor work with an initial Bhler angle less than 0 degrees, Female worker's compensation patient who participates in heavy labor work with an initial Bhler angle >15 degrees, Male non-worker's compensation patient who participates in heavy labor work with an initial Bhler angle less than 0 degrees, Male worker's compensation patient who participates in heavy labor work with an initial Bhler angle >15 degrees, Female non-worker's compensation patient who participates in heavy labor work with an initial Bhler less than 0 degrees. In this episode, we review the high-yield topic of Exertional Compartment Syndrome from the Knee & Sports section. In this episode, we review the high-yield topic of Quadrilateral Space Syndrome from the Shoulder & Elbow section. Treatment of calcaneal fractures has to be tailored to the individual pathoanatomy. Ankle Fractures. 1 . Most calcaneal fractures are occupational, and are caused by axial loading from a fall [ 2 ]. The video will appear on the video dashboard once complete. Which of the following statements is true regarding the superomedial fragment of an intra-articular calcaneus fracture? A 25-year-old woman began training for a marathon and she reports a 2-week history of heel pain. Key Points: Fractures of the pediatric calcaneus are rare injuries and are frequently missed. Calcaneal fractures usually occur after a high-energy accident, such as in a motor vehicle crash or a fall from a great height. In this episode, we review the high-yield topic of Congenital Vertical Talus from the Pediatrics section. Foot Ankle Int. eCollection 2022 Jun. The flexor hallucis longus tendon lies underneath the sustentaculum and if screw placement to the sustentacular fragment is too long, this could affect the flexor hallucis longus tendon, causing fixed flexion of the big toe. 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