Calcaneus FracturesBY DR HARSIMRANJEET SIDHU

Introduction

2 % of all fractures…….of these:- Displaced intra articular comprising of 60 to 75

% of these injuries 10 % asso with spine injuries 26 % with other extremity injuries. Compartment syndrome Age group 21 to 45 years…usually in men as they

are more into construction and industrial work.

anatomy

Mechanism of injury (Essex Laprosti)Usually caused by axial load mechanism. Can be fall from height, motor vehicle accident…….making it reason to check for other axial load injuries such as lumbar , pelvic and tibial plateau fractures.

How this axial load mechanism works

Contact point with calcaneum…(that is with above lying bone tallus )…is situated lateral to weight bearing axis of lower extremity.

Now as this axial load force is applied via tallus over the posterior facet of calcaneum….as shearing force…..which gets directed from posterior facet to medial wall of calcaneus.

All this will result in…………………………………………………………..

Primary Fracture lineAlmost always present ….extending from proximal medial aspect of calcaneal tuberosity, through anterolateral wall.

Now this fracture can be positioned on posterior facet

Over medial third..nearsustentaculum tali,

The central third

Or lateral third near lateral wall

Continuing with AXIAL FORCE OVER CALCANEUM

NOW as the axial force continues medial spike or fragment attaced to sustentaculum tali pushed further toward the medial aspect of heel.

Various further secondary fracture lines occur in the region of posterior facet……

Essex Lopresti classification based on xray If fracture line producing

posterior facet fragment exits behind the posterior facet and anterior to Achilles tendon attachment…it is JOINT DEPRESSION TYPE

If it is exiting distal to Achilles tendon insertion …it is TONGUE TYPE.

Joint depression type Tongue type fracture

Radio graphic evaluation

Xrays should include five views.

Lateral viewto aces height loss…..which is asssed by ‘bohler angle’

Bohler angle is angle between line drawn from highest point of anterior process of calcaneus to the highest point on posterior facet….and a line drawn tangentially from posterior facet highest point to tuberosity superior edge….normally angle is 20 to 40.

Decrease in angle indicate weight bearing posterior facet has collapsed .

Gissane’s angleTwo strong cortical struts ….one

extending along lateral margin of posterior facet and other extending anterior to beak of calcaneum,,

Comes directly below lateral process of tallus

Form obtuse angle …that is more than 90…..

Ap and olblique views to acess anterior process and clcaneo cuboid involvement…

Brodens view – wich will demonstrate posterior facet.

Classification based on ct scan.

Sanders classification…

Based on ct images in coronal plane.Calcaneum is

Divided into 3 potential fragments- Medial, central

And lateral….4 th potential fragment Is added up

By adding sustentaculum.

Type 1

All non displaced articular fragments . Regardless of number of fracture lines are considered

Type 2

Two part fracture of posterior facet. 2a , 2b and 2 c existed on basis of location of primary fracture line.

Type 3Three part fractures that usually featured centrally depressed fragment.Again as in type 2…..based on fracture line…it includes 3AB, 3 AC and 3 BC.

Type 4

4 Part articular fractures, highly comminuted and often have more than 4 articular fragments

Treatment

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