Calcaneus fracture

Background

Bones of the foot.

• Associated injuries are common

Types

• Intra-articular (75%)
  • Sclerotic line may be only evidence of impacted fracture
• Extra-articular (25%)
  • Anterior process fracture is most common

Clinical Features

• Foot pain after trauma - often from axial load such as fall from height or motor vehicle accident

Differential Diagnosis

Foot and Toe Fracture Types

Hindfoot

• Talus fracture
• Calcaneus fracture

Midfoot

• Lisfranc injury
• Navicular fracture
• Cuboid fracture
• Cuneiform fracture

Forefoot

• Fifth metatarsal fracture
• Non-fifth metatarsal fracture
• Toe fracture

Evaluation

(A) Normal Boehler's angle and (B) Abnormal Boehler's angle

• Plain X-ray imaging
  • Decreased Boehler's angle (<25') may be only sign of fracture (compare with opposite side)
  • Harris view to tuberosity
• Up to half of patients with calcaneus fractures have concomitant injuries including compression fractures of thoracolumbar spine

Management & Disposition

General Fracture Management

• Acute pain management
• Open fractures require immediate IV antibiotics and urgent surgical washout
• Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention
• Consider risk for compartment syndrome

Intra-articular fracture

• Immobilization with posterior ankle splint
• Non-weight bearing
• Elevation (very important - fracture has high rate of severe swelling)
• Ortho consult

Extra-articular fracture

• Immobilization with posterior ankle splint
• Close ortho follow up

See Also

• Foot Fractures
• Foot Diagnoses (Main)

Video

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