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Calcaneus Fracture
• Mechanism:– High energy axial load
• Intra or extraarticular
• Associations:– 7% bilateral– 10% spine compression #– 25% other LE injury
Calcaneus Fracture
• Imaging:– Standard AP/Lat foot and ankle views– Axial– +/- CT
• Important distinctions:– Involvement of subtalar joint– Depression of posterior facet
Calcaneus Fracture
• Ortho:– Treatment patterns vary– Intraarticular and comminuted fractures must
be seen
• Outcomes:– Poor outcomes– >50% have loss of ROM, chronic pain, and
functional disability
Talar fractures
• Minor talar fractures:
– HEAD AND NECK:• Avulsion and chip
fractures of superior surface
– BODY:• Lateral, medial,
posterior body AND osteochondral of talar dome
• Require immobilization and referral to ortho for f/u
Talar fractures
• Talar neck fractures– 50% of major talar
injuries.
– Mechanism:• extreme
dorsiflexion
– Hawkins classification
– Often associated fractures
Talar fractures
• Type 1: nondisplaced• Type 2: subtalar subluxation• Type 3: dislocation of the talar body (50% open #’s)
• Type 4: dislocation of the talar body & distraction of the
talonavicular joint.
Fracture type influences management & prognosis
Talar fractures
• Talar body fractures
– 23% of all talar fractures
• Ie posterior or lateral process fracture
– Major talar body fractures are uncommon
• usually axial loading
Talar fractures
• Talar head fractures– Uncommon (5-10%)
– Compression transmitted through the talonavicular joint applied on a plantarflexed foot
Talar fractures
• Management:– Major fractures
require ortho consult
• Outcomes:– Risk of AVN, OA, and
chronic pain
Navicular Fracture
• Classification:– Dorsal avulsion
• >50% of navicular #s • Eversion injury • Associated with deltoid
ligament injury• Minimal articular
involvement
– Tuberosity Fracture
• Eversion injury• Associated with
posterior tibialis tendon avulsion
Navicular Fracture
• Classification:– Body Fracture
• Rare• Axial loading• Comminuted,
intraarticular
Navicular Fracture
• Clinical– Pain on palpation– +/- pain on passive
eversion or active inversion
• Imaging– Standard foot views– +/- bone scan
Navicular Fracture
• Why do we care?– Significant risk of AVN
• Management:– Outpatient Ortho:
• Dorsal avulsion and tuberosity # with minimal articular involvement
• Immobilize 4-6 wks
– ED Ortho consult• Body#, displaced #, >20% of articular
surface involved