Presentation

 

Mechanism of Injury

1. Most common cause is fall from a height – often concomitant injuries – lumbar injuries or fractures
   • Should get leg, ankle, and lumbar films to rule out concomitant injury
   • Calcaneal fracture rarely occurs alone with a fall from a height
2. MVA - Second most common

 

Plantar ecchymosis – hallmark of calcaneal fracture

• Not seen often with ankle fractures
• Calcaneus is vascular and bleeds quite a bit with a fracture

 

Marked edema

• Fracture blisters may occur
• Longer you wait to repair the increased incidence of infection and wound dehiscence  due to edema
• Consider compartment syndrome – most compartment syndromes in feet are from calcaneal fractures

 

Pain around heel

Equinus gait

 

Mechanism of Fracture

 

Palmer – JBJS 1948

• Primary fracture line based on talus coming down on sustentaculum tali – shearing off of middle facet of sustentaculum tali

 

1. Primary fracture line
   • Begins medially and exits superiorly through the posterior facet
   • With continued compressive forces, the lateral process of talus impacts Gissanes angle
2.  Secondary fracture line
   • Continued forces push the posterior facet  into body of calcaneus
   • More vertical force – tongue fracture
   • Most posterior force – same as Essex-Lopresti – joint depression fracture

 

Peter Essex-Lopresti – BJS 1952

1. Primary fracture line
   • Caused when there is a vertical force (from the ground up)
   • Primary fracture line caused by the lateral process of talus impacting Gissane’s angle acting as a wedge to split calcaneus in half
2. Secondary fracture line
   • Occurs with continued compressive forces and body of talus is pressed into calcaneus – 2 secondary fractures can occur
   • Forces in vertical nature
     • Fracture exits calcaneus posteriorly – tongue fracture
   • More posterior directed force
     • Fracture line exits back up superiorly into the posterior facet – joint depression fracture

 

Resultant Deformity

• Joint incongruity – usually posterior facet

• • Can lead to DJD

• Decreased calcaneal height compression of calcaneus
  • limb length difference

• Increased calcaneal width
  • Soft tissue impingement – peroneal tendons and sural nerveà peroneal synovitis and sural nerve entrapment
  • Can’t fit in shoe – too wide