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Fracture calcaneum

Fracture calcaneum. Calcaneus fracture or heel fracture is a very common fracture of the of the foot. Functions : Supports weight of the body Acts as a spring board for locomotion . Bones of the foot . . Parts .

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Fracture calcaneum

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  1. Fracture calcaneum • Calcaneus fracture or heel fracture is a very common fracture of the of the foot. Functions : • Supports weight of the body • Acts as a spring board for locomotion

  2. Bones of the foot

  3. .

  4. Parts

  5. Extra-articular fractures of the body of calcaneus are caused by a fall from height. These fractures can be • undisplaced (hairline) or minimally displaced • displaced fractures in which the bone fragment has moved proximally (upwards) • comminuted (multiple bone pieces) fractures that result in widening of the bone

  6. Two types : • extra-articular or those fractures that do not involve the subtalar and calcaneo-cuboid joints • intra-articular or those fractures that involve the subtalar and calcaneo-cuboid joints • Extra-articular fractures constitute about 1/4 th of all fractures of calcaneum and they are of the following types : • tuberosity • sustentaculum tali • anterior process • medial process • body of the calcaneus

  7. Extra-articular fracture

  8. Cont… Extra-articular fractures : - • sustentaculum tali, anterior process, medial process, are caused by injuries that twist the foot. • Undisplaced fractures of the sustentaculum tali and anterior process are treated by : - • immobilization of the foot in a plaster cast for 6 to 8 weeks. • Displaced fractures are treated by surgery. • Fractures of the medial process are treated by plaster cast immobilization for 4 to 6 weeks.

  9. This x ray shows a undisplaced extra-articular fracture of the body of calcaneus. Red arrows point to the fracture lines.

  10. Intra-articular fractures • are caused by • vertical loading force on the calcaneus, such as fall from height. • constitute the remaining 3/4 th of calcaneal fractures. • Essex-Lopresti classification : - • tongue type • joint depression type

  11. Essex – lopreti`s classification

  12. Classification • Classification of intra-articular fractures according to Sanders using CT scanning • Type 1 are undisplaced • Type 2 are two part or split fractures • Type 3 are 3 part or split depression • Type 4 are comminuted or having multiple fragments

  13. Symptoms • severe pain and rapid swelling inability to walk or patient walks on his toes • dark reddish discolouration of the sole and skin of the heel due to seepage of blood • associated fractures of the back or the other bones of the lower limb may be present • Less severe symptoms are seen in extra-articular fractures.

  14. Diagnosis • x rays of the foot in different positions : - • X rays of the opposite uninjured foot are also taken to compare the change in the Bohler angle • CT scans may also be required for classification and better evaluation of the fracture.

  15. Fractures of the tuberosity caused by :- • a sudden forceful contraction of the calf muscles. • more common in elderly people because of osteoporosis. • Undisplaced tuberosity fractures : - • treated by plaster cast immobilization for 6 to 8 weeks. • Displaced fractures require surgery. • If surgery is not done then the calf muscles will become weak and ineffective. • After surgery a plaster cast is applied for 6 to 8 weeks.

  16. Tuberosity #

  17. Initial treatment • All calcaneus fractures (extra and intra-articular) includes : - • Bed rest • Elevation of the foot • Use of ice to reduce swelling • Anti -inflammatory medication to decrease pain and swelling

  18. Treatment According to classification : - • In Type 1 and undisplaced type 2 and 3 fractures • exercises are started as soon as the swelling decreases and pain allows. • The patient is not allowed to walk on his heel for at least 6 weeks. • Displaced type 2 and 3 fractures :- • are treated by surgery in which the fracture fragments are re-aligned and held with plate and screws. • In Type 4 fractures :- • Improve the alignment of the fracture by manipulation they are then treated similar to type 1 fractures. • In these fractures perfect anatomy can not be restored because of multiple fragments, hence the goal of treatment is to get the patient mobile as quickly as possible

  19. Complications • Immediate complications includes : - • injury to the skin, • nerves and • blood vessels by displaced fracture fragments • Compartment Syndrome in the foot • Late complications includes : - • arthritis • irritation and pressure over peroneal muscle tendons • bone spur (bony growth formed on normal bone ) formation causing heel pain

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