This issue of eMedRef provides information to clinicians on the pathophysiology, diagnosis, and therapeutics of calcaneus fractures

Barnett, Tiffany

Chan, Jonathan

Diaz, Manual

English

University of Missouri: MOspace

Sports Calcaneus Fractures Page 1 of 3    5.14.08 Calcaneus Fractures  See also Calcaneus fractures (Ortho)  Background 1. Calcaneus supports entire body wt during gait  o Articulates w/talus via subtalar/ talocalcaneal joint 2. Calcaneus and talus comprise hindfoot 3. Fractures in athletes seen in running/ jumping sports  o Rock climbing (falls) o Sky diving o Free running "jumping off things"  Pathophysiology 1. 2% of all fractures treated 2. Extra-articular fractures: 30%  3. Intra-articular fractures: 70%  4. Mechanisms of injury  o Direct, high-energy axial load from running, jumping or falls o Stress fracture: consider osteopenia 5. Greater than 50% association w/other extremity or vertebral fracture 6. 7% have contra-lateral calcaneal fracture 7. 25% have concurrent lower extremity fracture  Diagnostics 1. Presentation  o Heel pain o Swelling o Mondor sign   Ecchymosis distal to sole of foot 2. X-Ray  o AP, lateral o Axial view (Harris view) if strong suspicion o Fracture best seen in lateral view 3. CT used to assess degree of comminution or injury severity 4. Bohler's angle (rates severity of compression in intra-articular fractures)  o Created by intersection of line drawn from posterior tuberosity to posterior facet apex w/line from posterior facet apex to anterior process o Normal = 20-40°  o <20° suspect calcaneal fracture 5. Classification  o Intra-articular: involves subtalar joint o Extra-articular: does not involve subtalar joint      Sports Calcaneus Fractures Page 2 of 3    5.14.08  Therapeutics 1. Intra-articular or displaced fractures  o Orthopedic consultation for ORIF 2. Stress fractures  o Elevate o Non-wt bearing for 6-8 wks  Prognosis 1. Return to activity  o Stress fracture: gradual return to training 6-8 wks after injury o Fracture requiring surgical repair: 4-6 mos post operative   Depends on severity 2. Complications  o Early complications   10% incur compartment syndrome  5% will have deformities   Toe clawing  Stiffness  Neurovascular dysfunction o Late complications   Infection  Arthritis  Neuritis 3. Disability  o Pain o Loss of mobility o Functional impairment   50% even w/optimal tx  Patient Education 1. http://familydoctor.org/online/famdocen/home/healthy/physical/sports/147.html  References 1. 1. Germann CA, Perron AD, Miller MD, et al. Orthopedic Pitfalls in the ED: Calcaneal Fractures. Am J Emerg Med 2004; 22:607-611. 2. Judd DB, Kim DH. Foot Fractures Frequently Misdiagnosed as Ankle Sprains. Am Fam Physician 2002; 66(5):785-94. 3. Knight JR, Gross EA, Bradley GH, et al. Boehler's Angle and the Critical Angle of Gissane are of Limited Use in Diagnosing Calcaneus Fractures in the ED. Ann Emerg Med 2006; 24(4):423-7. 4. Aldridge T. Diagnosing Heel Pain in Adults. Am Fam Physician 2004; 70(2):332-8. 5. Nicklebur MD, Scott et al. "Calcaneus Fractures." EMedicine. 27 Jan 2005. WebMD. 24 Sept 2007 http://www.emedicine.com/orthoped/topic33.htm  Authors:  Jonathan Chan, DO, Manual Diaz, DO, & Tiffany Barnett, MD  Editor:  Carol Scott, MD, University of Nevada Reno FPRP Sports Calcaneus Fractures Page 3 of 3    5.14.08  

Calcaneus fractures

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Calcaneus fractures

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