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Transcript of Calcaneal Fractures
Articulates with the cuboid bone anteriorly and the talus bone superiorly. Responsible for transmitting the majority of the body's weight from the talus bone to the ground. AKA the "lover's fracture" - derived from the fact that a lover may jump from great heights while trying to escape from the lover's spouse Located anywhere outside the subtalar joint.
Categorised depending on whether the involvement of the calcaneus is anterior (Type A), Middle (Type B) or Posterior (Type C). Calcaneal fractures are categorised into two types: Intra-articular Extra-articular More common (70-75%)and involve the posterior talar articular facet of the calcaneus. The Sanders system classifies these fractures into four types, based on the location of the fracture at the posterior articular surface. Pain Inability to weight bear Swelling Bruising Jones dressing/short leg cast.
Studies (Farber 2011 and Schuberth et all 2009) indicate favorable results for the percutaneous technique compared with the open technique in type 2 sanders. Conservative Treatment Non-displaced (Sanders type 1) intra-articular fractures and extra-articular fractures. Surgical Intervention Displaced intrarticular fractures Currently, open reduction with internal fixation (ORIF) is usually the preferred surgical approach when dealing with displaced intrarticular fractures. Newer, more innovative surgical techniques and equipment have decreased the incidence of intra- and post-operative complications. Any questions?? By Alice Thompson Wong et al (2008) conducted a study looking into the conservative managment of calcaneal fractures.
It involved 44 patients with intraarticular and extraarticular calcaneal fractures.
Using the Maryland foot score which considers pain, function, stability, support, shoes, stairs, terrain, cosmesis and ROM, they found patients with extraarticular fractures had significantly higher rating scores compared to those with intraarticular fractures
Generally, both group of patients had a good clinical outcome. Selected clinical trials comparing non-operative vs operative treatments for displaced intra-articular calcaneal fractures
Reference Year Patients Outcome Measures Results
Buckley et al. 2002 424 SF – 30. Bohler’s angle. Not statistically significant differences in functional
Complications. results between operative treatment and non-operative
treatment. Patients between 20 and 29 years, patients
who were not receiving Worker’s compensation, women,
patients with a light workload, with a higher Bohler’s angle,
with a single fracture, with a simple displaced
intra-articular fracture had better results with operative
treatment than with nonoperative treatment
Howard et al. 2003 459 Complications Patients treated surgically were more likely to develop
Barla et al. 2004 41 SF – 30. Better results from operative treatment compared to
O’Brien et al. 2004 319 SF – 30. Personal gait satisfaction score.
Thordarson et al. 1996 30 Outcome assessment Better results of operative treatment
questionnaire (pain, daily compared with non-operative.
activity, walking limitations,
shoe wear, exercise, work)
Closed reduction with percutaneous fixation.
Associated with less wound complications, better soft tissue healing and decreased intraoperative time.
This procedure has increased risk of inadequate calcaneal bone fixation, compared to open procedures
Barla J, Buckley R, McCormack R, et al.(2004) Displaced intra-articular calcaneal fractures: long-term outcome in women. Canadian Orthopaedic Trauma Society. 25(1) pp. 853-856
Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, Galpin R. (2002) Journal of Bone Joint Surgery. 84(1) pp. 1733-1744.
Farber, D. (2011) Treatment of Displaced Intra-Articular Calcaneal Fractures with Closed Reduction and Percutaneous Screw Fixation. The Journal of Bone and Joint Surgery. 93(10)
Howard, J. L.; Buckley, R.; McCormack, R.; Pate, G.; Leighton, R.; Petrie, D.; Galpin, R. (2003) Journal of Orthopaedic Trauma. 17(4) pp. 241-249
O'Brien J, Buckley R, McCormack R, et al. (2004) Personal gait satisfaction after displaced intraarticular calcaneal fractures: a 2–8 year followup. Foot Ankle Int 25(1) pp. 657-665
Rammelt et al (2008) Percutaneous treatment of less severe intra-articular calcaneal fractures. Clinical Orthoapedics and Related Research. 468 (4) pp. 983-990.
Schepers et al (1996) Percutaneous treatment of displaced intra-articular calcaneal fractures. Journal of Orthopaedic Science. 12 (1) pp. 22-27.
Thordarson DB, Krieger LE. (1996) Operative vs.non-operative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int 17(3) pp. 2-9.
Wong et al (2008) Conservative management of calcaneal fractures. A retrospective review of treatment outcomes. Malaysian Orthopaedic Journal. 2 (1) pp. 28-32. References PHYSIOTHERAPY Rest, ice, elevation and compression. Maintain ROM and strength of unaffected joints and the other leg with regular exercises. Decision made by surgeon regarding treatment Mobilise patient as per surgeon's instructions - generally non-weight bearing. ROM exercises Progress weight-bearing status Gait re-education Balance and proprioception exercises