II. Epidemiology
- Most commonly Fractured tarsal bone
III. Mechanism: Compression Fracture most common
IV. Associated Injuries: Fall from height
- Lower thoracic or Lumbar Fracture (10% of Calcaneus Fracture)
- Palvic Fracture
- Other external injury (26% of Calcaneus Fractures)
- Bilateral Calcaneal Fractures are common in fall from height
- Pilon Ankle Fracture
- Hip Dislocation
V. Signs
- Swelling, pain, and Ecchymosis at Calcaneus
- Evaluate distal circulation, motor function and sensation (risk of Compartment Syndrome)
VI. Imaging
-
Foot XRay
- Standard Foot Anteroposterior and lateral views
- Obtain calcaneal views (with Harris axial heel view)
- Bohler Angle
- Technique
- Interpretation
- Bohler angle is normally 20-40 degrees
- Suspect Fracture when Bohler Angle <20 degrees
- Critical Angle (Angle of Gissane)
- Technique
- As with Bohler angle, measure critical angle on lateral XRay
- Draw similar lines as Bohler angle
- Critical angle is the up facing, obtuse angle (90-180) between the upward slopes of the lines
- Interpretation
- Critical angle is normally 130-145 degrees
- Suspect Fracture when Critical angle >145 degrees
- Technique
- CT Foot or MRI Foot as indicated
- Often needed to guide surgical management
VII. Management: Acute
- Evaluate for surgical emergencies (see below)
- Compartment Syndrome
- Tongue-Type (extra-articular Fracture)
-
Splinting
- Bulky Bobby Jones splint with both sugar tong and posterior splint applied
- Copious padding should be applied (especially at heel) to prevent ulcers
- Avoid trapping the fifth toe under the fourth (risk of ulcer)
- Other measures
- Close interval follow-up and evaluation for possible surgical repair
- DVT Prophylaxis (e.g. Lovenox 40 mg SQ daily)
- Non-weight bearing for 6-8 weeks
- Elevate the leg
VIII. Management: Surgical Management
- Emergent Surgery Indications
- Compartment Syndrome
- Tongue-Type (extra-articular Fracture)
- Subtalar fusion indications (and risk factors)
- Bohler's Angle <0 degrees
- Sanders Type 4 Fracture
- Workers compensation claim
- Male gender
- Other surgical indications
- May be necessary to Restore accurate anatomy
- Indications for non-surgical, conservative management
- Small, extraarticular Fractures (without achilles tendon involvement)
- Small anterior process Fracture
- Calcaneal Stress Fracture
IX. References
- Feden and Kiel (2017) Crit Dec Emerg Med 31(11): 3-10
- Orman and Ramadorai in Herbert (2017) EM:Rap 17(3): 12-3
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Concepts | Injury or Poisoning (T037) |
ICD10 | S92.0 |
SnomedCT | 208706003, 208676009, 157251006, 263247007 |
English | Fracture of calcaneus, fracture of calcaneus, fracture of calcaneus (diagnosis), Fractured os calcis, Os calcis, Heel bone, fracture calcaneus, fracture heel, heel fracture, calcaneus fracture, fractured os calcis, heel bone fracture, fractures heel, calcaneus fractures, fracture of os calcis, of calcaneus fracture, Calcaneus fracture, Os calcis fracture, Fracture of os calcis, Heel bone fracture, Fracture of calcaneus (disorder), calcaneus; fracture, fracture; calcaneus, fracture; heel bone, fracture; os calcis, heel bone; fracture, os calcis; fracture, os calcis, fractured calcaneus, Fracture;calcaneus |
Dutch | gebroken os calcis, calcaneusfractuur, calcaneus; fractuur, fractuur; calcaneus, fractuur; hielbeen, fractuur; os calcis, hielbeen; fractuur, os calcis; fractuur, Fractuur van calcaneus |
French | Fracture du calcanéum, Calcanéum fracturé |
German | gebrochener Os calcis, Fersenbeinfraktur, Fraktur des Kalkaneus |
Italian | Calcagno fratturato, Frattura del calcagno |
Portuguese | Os calcis fracturado, Fractura do calcâneo |
Spanish | Calcáneo fracturado, Fractura del calcáneo, fractura del calcáneo (trastorno), fractura de calcáneo (trastorno), fractura de calcáneo, fractura del calcáneo |
Japanese | 踵骨骨折, ショウコツコッセツ, シュコツコッセツ |
Czech | Zlomená kost patní, Zlomenina kosti patní |
Korean | 발꿈치뼈의 골절 |
Hungarian | Fractura ossis calcanei, Calcaneus törés |