Calcaneus Fracture
Calcaneus Fracture Animations animated gif Rotating 3D models of different types of calcaneus fractures:  body, medial process, sustentaculum tali, tuberosity.
Calcaneus Fracture X-rays picture album Plain film radiographs of the heel including illustrations of Bohlerís and Gissaneís angles. Calcaneus Fracture CT animated gif Scrolling through a CT scan of a calcaneus fracture.
The calcaneus is one of the tarsal bones of the hindfoot.  It is commonly referred to as the heel bone.  A calcaneus fracture, in simple terms, is a broken heel bone. Calcaneus fractures are often the result of high-energy injuries such as a fall from a height or a motor vehicle accident.  X-rays: AP, lateral of foot AP, lateral, oblique of ankle Harris view (axial heel view) Consider x-rays of the lumbar spine due to the high incidence of associated vertebral fractures CT scan: If the fracture is intra-articular (involves the joint surface), a CT scan should be obtained. MRI: If no fracture is identified but a stress fracture is suspected, an MRI may confirm this. Classification: Extra-articular o Anterior process (often missed; “sprain fractures”) o Tuberosity Open beak Avulsion at insertion of Achilles tendon o Sustentaculum tali o Body - not involving the subtalar joint o Medial process o Lateral process Intra-articular body o Tongue type - intra-articular fragment attached to tuberosity fragment o Joint-depression type - intra-articular fragment not attached to tuberosity fragment Stress fractures
Initial management: Emergent orthopedic surgery evaluation: o Open fractures o Fracture-dislocations (need reduction) o Compartment syndrome Urgent orthopedic surgery evaluation: o Intra-articular fractures o Displaced extra-articular fractures Bulky compression splint (Robert-Jones) Pack in ice Elevate Non-weightbearing Pain control Definitive treatment: Anterior process o Nondisplaced or minimally displaced 1 week compression splint to allow for swelling Short leg cast 4-6 weeks - neutral position Physical therapy for range-of-motion, proprioception, strengthening o Displaced or involving > 25% of articular surface with cuboid Surgery Closed reduction - percutaneous pinning Open reduction - internal fixation Medial or lateral process o Nondisplaced or minimally displaced 1 week compression splint to allow for swelling Short leg cast 8-10 weeks - neutral position Physical therapy for range-of-motion, proprioception, strengthening o Displaced Closed reduction with well-molded cast Surgery if unable to obtain good reduction or unstable Short leg cast 8-10 weeks - neutral position Physical therapy for range-of-motion, proprioception, strengthening Tuberosity o Nondisplaced or minimally displaced, uncompromised skin 1 week compression splint to allow for swelling Short leg cast 6-8 weeks - 5-10° plantar flexion Physical therapy for range-of-motion, proprioception, strengthening o Displaced or skin tenting or wounds Surgery Suture fragment in place, suture anchors, tension band wiring Consider screw fixation if large fragment and good quality bone Sustentaculum tali o Nondisplaced 1 week compression splint to allow for swelling Short leg cast 6-8 weeks - 5-10° plantar flexion Physical therapy for range-of-motion, proprioception, strengthening o Displaced Surgery Open reduction - internal fixation Body o Not involving subtalar joint and < 1 cm displaced 1 week compression splint to allow for swelling Short leg cast 10-12 weeks - 5-10° plantar flexion Physical therapy for range-of-motion, proprioception, strengthening o > 1 cm displaced or involving subtalar joint Closed reduction - percutaneous pinning Open reduction - internal fixation Stress fractures o Mild pain CAM walker boot, heel inserts Weight-bearing permitted Activity restrictions o Severe pain Non-weightbearing in boot or cast Gradual return to normal activity over 4-6 weeks