Calcaneal Fracture-Plain Film

56 yr old with history of fall from ladder. Case discussion series by Dr MGK Murthy.


1.What is it?
It is calcaneal fracture–comminuted, intra articular variety of tuberosity fragment fracture with Bohlers angle reduced

2.How many type are there?
Mainly two- Intra (important) and extra articular

3. Subtypes?
Primary fracture line is through the posterior  facet (uncommonly it can be anterior or middle)

Three-
a) sustentacular fragment(constant)
b) Tuberosity fragment------- leads to incongruity of post facet ---widening and shortening of heel------further damage-----tuberosity fragment creation(superolateral fragment of posterior facet)
c) if axial load bearing continues –Thalamic fragment(depressed posterior part of the posterior facet)


4. Complications ?
Calcaneal cuboidal joint displacement Tendoachilles/peroneal tendons distraction
Heel short and wide
lateral wall comminution/talus dorsiflexion

5.Associated injuries? (Mechanism -fall from height)
Other foot/spinal
Soft tissue compartmental syndromes
Fracture blisters

6.Radiography?
True lateral and oblique play more role along with other side comparison in case of doubt. Bohlers angle (normally 20 -40 deg)(intersection line drawn from the most cephalic portion of tuberosity to highest point of posterior facet)is critical.

7.Best way to calculate?
MDCT

8. Management
Initially all -with rest and elevation till swelling subsides
Then if bohlers angle mildly or moderately reduced – conservative, if severely reduced (< or equal to 0)- surgery