Therefore, treatment requires the repair of multiple fractures in the heel bone, as well as restoring the subtalar joint. D present calcaneal fractures preoperatively and 6 weeks postoperatively reconstructed using a calcaneal plate. Heel bone or calcaneal fractures are are the most common of all rearfoot fractures in adults, representing 60%. Open fractures will most likely present with a laceration or puncture wound on the medial aspect of the foot. Review article calcaneal reduction forceps for minimally. Calcaneal heel bone fractures diagnosis, classification. Conservative management for calcaneal fractures is an acceptable mode of treatment with satisfactory functional outcome. The second report is by brunet, 10 who reported on 19 fractures in 17 patients age 1. Research studies suggest that outcomes can be similar regardless of treatment choice but surgery seems to favor better outcomes in low risk patients and is less favorable in high risk patients. The heel bone is like an egg with a strong shell and a soft interior.
Clinical evidence supporting operative treatment for selected patient groups is limited, whereas longterm complications and adverse outcomes are frequently documented 1. Fixation with metallic plates and screws has been proven to be effective in providing enough stability for bone union. Fracture characterization is essential to guide the management of these injuries. Jan 05, 2011 currently, open reduction and internal fixation orif with metallic plates and screws is widely used in the surgical treatment of intraarticular calcaneal fractures. Surgical treatment of comminuted calcaneal fractures. Surgical treatment of comminuted calcaneal fractures using. Calcaneus fracture repair physical therapy protocol.
Historically, treatment of displaced intraarticular calcaneal fractures has varied from nonoperative management with or without closed reduction, to open reduction with internal fixation by various surgical approaches, to primary arthrodesis. Inokuchi and associates 58 reported on 20 calcaneal fractures, and ages at the time of injury ranged from 1 to 14 years mean, 8. Calcaneus fractures may be difficult to heal as the connecting joints and bones may also need to be repaired. Nov 08, 2017 operative treatment is recommended for displaced intraarticular calcaneal fractures involving the posterior facet with more than 2 mm of displacement, fracturedislocations, and fractures with. Calcaneus fracture management has been a source of controversy for at least. Calcaneus fractures pediatric orthopaedic society of. Recent studies have sh own that 75% of foot function is affected by atment. Jun 08, 2016 calcaneal fractures extra articular fractures everything you need to know dr. The management of some types of displaced intraarticular calcaneal fractures remains contentious. Full text get a printable copy pdf file of the complete article 2. Symptoms may include pain, bruising, trouble walking, and deformity of the heel.
The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2 and 60% of all tarsal fractures 3. These fractures present many challenges to the treating surgeon, including bony comminution, sometimes severe soft tissue. The treatment of choice for acute displaced intraarticular calcaneal fractures remains controversial. Twelve 60% of the fractures were extraarticular, a higher percentage than in. Therefore, the heel bone often shatters when it is traumatized by a fall or accident. Seventytwo percent of these fractures resulted from falls. Calcaneal fractures are rare in children but frequent in adults. Fractures of the calcaneus heel bone fractures foot. Operative treatment of intraarticular calcaneal fractures. Calcaneal heel bone fractures diagnosis, classification and. This classification is based on the number of intraarticular fracture lines and their location on semicoronal ct images. For some fractures, nonsurgical treatments may be used. Original article treatment of open calcaneal fractures.
Usually due to a fall from a height at work or a road traffic incident, calcaneal fractures are often intraarticular and displaced, affecting primarily the subtalar joint. Numerous controversies surround the management of patients with calcaneal fractures. Nonsurgical treatment is for extraarticular fractures and sanders type i intraarticular fractures, provided that the calcaneal weightbearing surface and foot function are not compromised. We report 18 cases 20 feet of pediatric calcaneal fractures before the distal tibial growth line closed to assess the characteristics of pediatric calcaneal fractures and reveal differences in treatment and prognosis between children and adults. Calcaneal and talar fractures and dislocationspart i. But even with appropriate treatment, some fractures may result in longterm complications, such as pain, swelling, loss of motion, and arthritis. Calcaneal fractures present as a shortenedwidened heel with varus deformity. Retrospective analysis of 18 cases of open calcaneal fractures patients who were recruited from may 2007 to may 2012, including males and 5 females. Calcaneal fractures evaluation and surgical treatment youtube. Heuichul gwak, md, jeongyo kim, md, junghan kim, md, sangmyung roh, md. Primary subtaler arthrodesis for the treatment of comminuted calcaneal fractures. Aug 26, 2012 historical treatment1908, cotton and wilson orif of a calcaneal fracture contraindicated recommended closed treatment with use of a medially placed sandbag, a laterally placed felt pad, and a hammer to reduce the lateral wall and reimpact the fracture. They only consist of 1,2% of all relatively rare injuries. Fractures of the pediatric calcaneus are rare injuries and are frequently missed.
Open versus closed operative treatment for tonguetype. The specific treatment strategy and fixation method for open. Calcaneal fracture 2020 riverside drive 5 p a g e green bay, wi 54301 9202885555 references. Management of the intraarticular calcaneal fracture is a challenge.
It is most useful for tonguetype fractures in which the displaced portion of posterior facet remains intact to the tuberosity. Courtesy of calcaneal heel fractures footeducation. A smaller number of calcaneal fractures are stress fractures, caused by overuse or repetitive stress on the heel bone. However, it is still difficult to treat open calcaneal fracture due to the anatomical features of the calcaneus and weak soft tissue coverage on the surface of the calcaneus. The greater part of fractures 71,5% are sustained in falls from a height from usually 6 feet or.
This bone supports the lateral column of the foot and carries our entire body weight while walking, which is why, a fractured heel bone is. General treatment guidelines can be summarized as follows. Intraarticular fractures of calcaneus current concepts of treatment. Calcaneal fractures have characteristic appearances based on the mechanism of injury and are divided into two major groups, intraarticular and extraarticular. The history of treatment of these fractures is characterized by periods of.
Surgical versus conservative interventions for displaced intraarticular calcaneal fractures. Some proposed indications are open fractures, fractures with softtissue compromise, such as burns or large areas of fracture blistering, and combined fractures that include calcaneal and ankle or midfoot fractures. Percutaneous treatment of calcaneal fractures request pdf. The most common etiology is a forceful axial load to the hindfoot, frequently occurring during a fall. A calcaneal fracture is a break of the calcaneus heel bone. Many studies have assessed the outcome of treatment of calcaneal fractures, but there is a. Calcaneal fractures are the most common tarsal fracture and can occur in a variety of settings. Primary subtalar joint arthrodesis in the treatment of. Calcaneal fractures are usually caused by highenergy trauma, with fall. Mondors sign or ecchymosis of the foot extending distally onto the heel is a hallmark of this injury. Johannes p, florian h, christoph k, benedikt k, ralph z, nicolas k.
Complications in calcaneal fracture surgery and implant removal. Calcaneus fracture repair physical therapy protocol pg 2 12 weeks progressive wb begins 12 week md visit. The fractures may be divided into extraarticular not affecting the joint and intraarticular involving the talocalcaneal and calcaneal cuboid. There are several surgical treatment calcaneal fractures 2.
The treatment of calcaneal fractures must be planned according to different factors such as. First described by essexlopresti in his classification of calcaneal fractures, tonguetype fractures extend into the subtalar joint with a secondary fracture line that runs straight back to the posterior border of the calcaneal tuberosity. The treatment of calcaneal fractures continues to be controversial. Calcaneal fractures can be divided broadly into two types depending on whether there is articular involvement of. To explore the clinical efficacy of selfdeveloped calcaneal external fixator for the treatment of open calcaneal fractures. Calcaneal fractures, treatments and problems omics international. Anatomy understanding the anatomy of these fractures is a prerequisite to understanding the operative management. Two patients developed chronic, draining calcaneal osteomyelitis, for which one patient underwent a belowknee amputation. Discuss fracture subtypes associated with open calcaneal fractures. Calcaneal fractures can also occur with other types of injuries, such as an ankle sprain. The optimal management of intraarticular calcaneal fractures is controversial.
However, it is still difficult to treat open calcaneal fracture due to the anatomical features of the calcaneus and weak soft tissue coverage on the. Treatment of calcaneal fractures is dictated by the type of fracture and extent of the injury. Calcaneal fracture is the most common of the tarsal fractures and represents 1%2% of all fractures. Surgical treatment of calcaneal fractures with bioabsorbable. It may be associated with breaks of the hip or back it usually occurs when a person lands on their feet following a fall from a height or during a motor vehicle collision. Describe secondary treatment options used in the management of this compound fracture. The majority are displaced intraarticular fractures 60 to 75 percent.
Treatment treatment of calcaneal fractures is controversial and both surgery and nonsurgical treatment is often considered reasonable. If surgery is contemplated it may be necessary to obtain a ct scan as this will give a more detailed view of the fracture pattern. Calcaneus fractures in children younger than 10 years of age, are usually extraarticular. A calcaneal fracture is one of the most common tarsal bone fractures that could occur in the event of overuse injuries or a fall from a great height. Introduction the calcaneus os calcis is the commonest tarsal bone to sustain fracture. Calcaneal fractures are mostly the result of a traumatic incident and high impact situation. Original article treatment of open calcaneal fractures using. In contrast to the disappointing results after nonoperative treatment and at the beginnings of calcaneal surgery, the outcome is promising nowadays. Types of calcaneal fractures fractures of the calcaneus may or may not involve the subtalar and surrounding joints. Treatment often involves surgery to reconstruct the normal anatomy of the heel and restore mobility so that patients can return to normal activity. Kolodziejski p, zarnocki l, wojdasiewicz p, rylka k, kuropatwa k, deszczynski j. There has been debate on the optimal treatment for displaced intraarticular fractures of the os calcis for more than a century 2, 3, 4.
Intraoperative threedimensional imaging in calcaneal fracture. Calcaneal fractures account for 23% of all fractures of the body, and 60% of all tarsal fractures. Displaced intraarticular calcaneal fractures are complex and highly disabling injuries. Although methods continue to improve, the treatment is challenging and complications are frequent. Fracture blisters may appear within 36 hours of injury. Jul 24, 2014 displaced fractures of the calcaneus, or heel bone, are a serious injury and the outlook for patients, who are typically young, remains poor. Most cases of a fractured bone can be treated naturally without surgery, while more serious fractures do require a surgical procedure. Management of intraaticular calcaneal fractures by. The calcaneus is the most frequently fractured tarsal bone.
Xray ankle, subtalar, forefoot, toe aarom gentle stretch and isometrics. This classification is useful not only in understanding typical fracture patterns of the calcaneus but also in predicting. The article describes in detail calcaneal anatomy, mechanism of calcaneal injuries and their associated fracture patterns, ct features of intra and extraarticular fractures, and management implications. The sanders classification system is used to assess intraarticular calcaneal fractures, which are those involving the posterior facet of the calcaneus. The foot and ankle surgeon will discuss with the patient the best treatmentwhether surgical or nonsurgicalfor the fracture.
Calcaneal fractures musculoskeletal medicine for medical. Research studies suggest that outcomes can be similar regardless of. Depending on the impact, the heel fracture may have multiple tiny. There is ongoing debate regarding the optimal treatment for each type of displaced intraarticular calcaneal. Intraarticular fractures have a poorer prognosis than extraarticular fractures. Operative versus nonoperative treatment for closed. In our series, for the patients with gustilo type ii and type iii open calcaneal fractures, there was an 11% complication rate with higher. The average time off work for patients with calcaneal fractures averages 7. Surgical treatment of displaced intraarticular calcaneal fractures correlates with. Secondary soft tissue compromise in tonguetype calcaneal fractures. They are under diagnosed often in children because of high percentage of cartilage present.
The optimal method of treatment remains controversial. The foot and ankle surgeon will discuss with the patient the best treatment whether surgical or nonsurgical for the fracture. Calcaneal fractures are the most common injury of the tarsal bone, accounting for 12% of all human fractures 1. Extraarticular fractures account for about 25%30% of calcaneal fractures and include all fractures that do not involve the posterior facet. Percutaneous fixation of calcaneal fractures has limited indications. Physicians may choose to perform closed reduction with or without fixation casting, or fixation alone without reduction, depending on the individual case. The surgeon must consider the patient and the fracture when making decisions about treatment. In a series of 50 fractures treated by four methods, open reduction with stabilization by bone grafts, followed by active motion at six to eight weeks, gave the best results. Open reduction and internal fixation compared with orif and primary subtalar arthrodesis for treatment of sanders type iv calcaneal fractures. Diagnosis is suspected based on symptoms and confirmed by xrays or ct scaning.
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