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Calcaneal Fractures

1/2/2015

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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:
Picture
Picture
Calcaneal Fractures:
-        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.

Diagnosis:
  • Plain flims: Obtain AP/lateral/oblique views.
  • Findings: reduced Bohler Angle.  (<25 degrees …normal is ~ 25-40)

Picture
CT Scans:
  • Plain films are fairly limited in the diagnosis and characterization of calcaneal fractures. 
  • CT is gold standard. 
  • Have a fairly low threshold for obtaining CT for further characterization of any suspected calcaneal fracture.

Classification: There are multiple levels of classification, but the most important delineation is between intra-articular and extra-articular fractures. 
  • Approximately 75% are intra-articular. 
  • Most classification systems are based on findings from CT scan. Sanders classification is generally used for intra-articular fractures:

Picture
As stated before -> Calcaneal fractures are associated with significant axial load so always consider other injuries including hip/pelvis, or lumbar spine fractures.

Treatment:
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.

Important complications:
o   Poor wound healing (particularly in smokers and diabetics)
o   Compartment syndrome
o   Arthritis

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  • RESIDENCY
    • About CMC
    • Curriculum
    • Benefits
    • Explore Charlotte
    • Official Site
  • FELLOWSHIP
    • EMS
    • Global EM
    • Pediatric EM
    • Toxicology >
      • Tox Faculty
      • Tox Application
    • (All Others)
  • PEOPLE
    • Program Leadership
    • PGY-3
    • PGY-2
    • PGY-1
    • Alumni
  • STUDENTS/APPLICANTS
    • Prospective Visiting Students
    • UNC/Wake Forest Students
    • Healthcare Disparities Externship
    • Resident Mentorship
  • #FOAMed
    • EM GuideWire
    • CMC Imaging Mastery
    • Pediatric EM Morsels
    • Blogs, etc. >
      • CMC ECG Masters
      • Core Concepts
      • Cardiology Blog
      • Dr. Patel's Coding Blog
      • Global Health Blog
      • Ortho Blog
      • Pediatric Emergency Medicine
      • Tox Blog
  • Chiefs Corner
    • Top 20
    • Current Chiefs
    • Schedules >
      • Conference/Flashpoint
      • Block Schedule
      • ED Shift Schedule
      • AEC Moonlighting
      • Journal Club/OBP/Audits Schedule
      • Simulation
    • Resources >
      • Fox Reference Library
      • FlashPoint
      • Airway Lecture
      • Student Resources
      • PGY - 1
      • PGY - 2
      • PGY - 3
      • Simulation Reading
      • Resident Wellness
      • Resident Research
      • Resume Builder
    • Individualized Interactive Instruction