Case: 27 year old Male s/p MVC with multiple open RLE fractures. Complains of severe pain at the BL ankles, unwilling to allow any further testing in the trauma bay. Plain films of single ankle below:
- Mechanism: Generally result from an axial load to the lower extremity. Typically either a fall from height while landing on one’s feet –or- from an MVC.
- Presentation: Patients may have a shortened and widened heel with varus deformity. Patients also may have “Mondor’s sign” which is ecchymoses of the foot extending into the heel.
Classification: There are multiple levels of classification, but the most important delineation is between intra-articular and extra-articular fractures.
As stated before -> Calcaneal fractures are associated with significant axial load so always consider other injuries including hip/pelvis, or lumbar spine fractures.
o For most extra-articular and type I intra-articular fractures: Immobilization with short-leg splint, strict non weight-bearing status, elevation, pain control. Patient will need ortho follow-up ASAP.
o For more severe fractures: Surgical fixation, if pursued, will vary depending on the patient’s comorbidities and the preference of the surgeon.
o Poor wound healing (particularly in smokers and diabetics)
o Compartment syndrome
CMC ER Residents
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