Calcaneal fracture

Calcaneal Fracture

A calcaneal fracture is a break in the calcaneus, also known as the heel bone. This type of fracture is often caused by high-energy trauma such as a fall from a height or a motor vehicle accident. Calcaneal fractures can be quite debilitating due to the critical role the calcaneus plays in weight-bearing and walking.

Calcaneal fracture

Anatomy

The calcaneus is the largest of the tarsal bones in the foot and forms the heel. It is crucial for normal foot function, providing support and stability. The calcaneus articulates with the talus above and the cuboid bone in front, forming part of the subtalar joint and the calcaneocuboid joint.

Types of Calcaneal Fractures

Calcaneal fractures can be classified into two main types:

• Intra-articular fractures: These involve the subtalar joint and are more common, accounting for about 75% of all calcaneal fractures. They are often more severe and can lead to long-term complications such as arthritis.
• Extra-articular fractures: These do not involve the subtalar joint and are less common. They may occur in the calcaneal tuberosity, the sustentaculum tali, or the anterior process of the calcaneus.

Diagnosis

Diagnosis of a calcaneal fracture typically involves a combination of physical examination and imaging studies.

CT scan of calcaneal fracture

Imaging

• X-rays: Standard X-rays are used to assess the fracture and include lateral, axial, and oblique views.
• CT scans: These provide a more detailed view of the fracture pattern and are particularly useful for intra-articular fractures.

Böhler's angle measurement

Böhler's Angle

Böhler's angle is an important measurement used in the assessment of calcaneal fractures. It is formed by the intersection of two lines: one from the highest point of the anterior process to the highest point of the posterior articular facet, and the other from the highest point of the posterior articular facet to the highest point of the calcaneal tuberosity. A normal Böhler's angle ranges from 20 to 40 degrees. A decrease in this angle is indicative of a fracture.

Gissane's angle

Gissane's Angle

Gissane's angle, also known as the "critical angle," is another important measurement. It is formed by the downward and upward slopes of the calcaneal superior surface. A normal Gissane's angle is between 120 and 145 degrees.

Treatment

Treatment of calcaneal fractures depends on the type and severity of the fracture. Options include:

• Conservative treatment: This may involve rest, ice, compression, and elevation (RICE), along with immobilization in a cast or splint.
• Surgical treatment: Surgery may be required for displaced intra-articular fractures. Techniques include open reduction and internal fixation (ORIF).

Rehabilitation

Rehabilitation is crucial for recovery and involves physical therapy to restore range of motion, strength, and function. Weight-bearing is typically restricted until the fracture has healed sufficiently.

Calcaneal fracture in neutral position

Prognosis

The prognosis for calcaneal fractures varies. Factors influencing recovery include the severity of the fracture, the quality of the reduction, and the presence of complications such as post-traumatic arthritis.

Related Pages

• Fracture
• Subtalar joint
• Orthopedic surgery