rowe calcaneal fracture classification rowe calcaneal fracture classification

(See Ankle Joint Anatomy.). The body of the calcaneus is composed primarily of cancellous bone, having a comparatively thin cortex. Mechanism and pathoanatomy of the intraarticular calcaneal fracture. Robert A Probe, MD Associate Professor of Orthopedic Surgery, Texas A&M University Health Science Center; Chairman, Department of Orthopedic Surgery, Scott and White Clinic and Memorial Hospital The subtalar joint is involved 75% of the time. Eckstein C, Kottmann T, Fchtmeier B, Mller F. Long-term results of surgically treated calcaneal fractures: an analysis with a minimum follow-up period of twenty years. 12. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. If compartment syndrome is not recognised early clawing of toes, stiffness, aching, sensory changes Dermatology [QxMD MEDLINE Link]. Calcaneal Fractures Flashcards | Quizlet Rowe Classification: Type 1A Medial tuberosity fracture Type 1B Sustentaculum tali fracture Type 1C Anterior process fracture Type 2A Posterior beak fracture (no achilles involvement) Type 2B Posterior beak fracture (achilles involvement) Type 3 Extra-articular fracture of body Type 4 Intra-articular fracture of body without collapse/depression J Foot Ankle Surg. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. Open reduction and stable internal fixation without joint transfixation has been established as standard therapy for most displaced intra-articular fractures with good to excellent results in more than two-thirds of patients in . Complications (eg, malunion or screw positioning deviation) occurred in six patients and delayed wound healing in one. Conservative versus operative treatment. if (document.referrer) document.write ("&referer=" + escape(document.referrer)); - intra-articular Microbiology and Infection Control Pain in heel region, tenderness, swelling, ecchymosis, distortion of anatomy. Int Orthop. 2002 Jan. 33 (1):263-85, x. Because it is the type of fracture that could . Compare minimally displaced calcaneal tuberosity fracture on patient's left side with comminuted intra-articular (Sanders type III) fracture on right. J Bone Joint Surg Am. [QxMD MEDLINE Link]. - Treatment of Displaced Intra-Articular Calcaneal Fractures with Closed Reduction and Percutaneous Screw Fixation Inversion, lateral tuberosity. Conferences Park CH, Yoon DH. Badillo K, Pacheco J, Padua S, Gomez A, Colon E, Vidal J. Multidetector CT Evaluation of Calcaneal Fractures. 2010 Jan-Feb. 49 (1):8-15. J Orthop Trauma. Vol 2: 2041-100. - in patients that performed heavy work: Background: 128 (6):585-91. - Treatment Options: - references: [Full Text]. - tuberosity fragment tilts into varus and is pulled proximally by the Achilles tendon; Calcaneal Fracture Classification: A Comparative Study Fractures of the Calcaneus: A Review with Emphasis on CT Sanders et al.'s original description of intraarticular calcaneal fracture classification was based on coronal and axial CT cross-sections with the widest undersurface of the posterior facet of the talus . Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. - The management of soft-tissue problems associated with calcaneal fractures. Medscape Education. Selim A, Ponugoti N, Chandrashekar S. Systematic Review of Operative vs Nonoperative Treatment of Displaced Intraarticular Calcaneal Fractures. Intra-articular fractures of the calcaneus: Present state of the art. Brunner A, Heeren N, Albrecht F, Hahn M, Ulmar B, Babst R. Foot Ankle Int. Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome. Cavadas PC, Landin L. Management of soft-tissue complications of the lateral approach for calcaneal fractures. 1993; (290): 87-95. In patients with calcaneus fractures and a history of falling from a height, evaluation of the thoracic and lumbar spine is indicated to assess for associated axial skeletal fractures. - 2 types of frx may occur: extra-articular and intra-articular: - intra-articular fracture: 2020 Jun. [QxMD MEDLINE Link]. History Mystery: Did Subdural Hematoma Kill Thomas Aquinas? Fischer S, Meinert M, Neun O, Colcuc C, Gramlich Y, Hoffmann R, Manegold S. Arch Orthop Trauma Surg. Zhong L, Xu Y, Wang Y, Liu Y, Huang Q. However, the sinus tarsi approach has limited exposure to the lateral wall, which. Foot Ankle Int. [QxMD MEDLINE Link]. CT is the modality of choice to evaluate calcaneal fracture. Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American College of Surgeons, American Orthopaedic Association, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma Association, Texas Orthopaedic AssociationDisclosure: Serve(d) as a speaker or a member of a speakers bureau for: Styker. Foot Ankle Orthop. Epub 2020 Oct 27. Calcaneus Fractures: Practice Essentials, Anatomy, Pathophysiology Potter MQ, Nunley JA. J Foot Ankle Surg. Types IV and V (60%) involve the subtalar joint. Eur J Transl Myol. [QxMD MEDLINE Link]. Calcaneus Fractures - Trauma - Orthobullets ORTHO BULLETS Free CME Join nowLogin Select a Community MB 1Preclinical Medical Students MB 2/3Clinical Medical Students ORTHOOrthopaedic Surgery About Bullet Health Please confirm topic selection Are you sure you want to trigger topic in your Anconeus AI algorithm? Vinod K Panchbhavi, MD, FACS, FAOA, FABOS, FAAOS Professor of Orthopedic Surgery, Chief, Division of Foot and Ankle Surgery, Director, Foot and Ankle Fellowship Program, Department of Orthopedic Surgery, University of Texas Medical Branch School of Medicine Bohler L. Diagnosis, pathology, and treatment of fractures of the calcaneus. Research Widening of heel Foot Ankle Int. Mahmoud K, Mekhaimar M, Alhammoud A. 2020 Oct 6;8(19):4400-4409. doi: 10.12998/wjcc.v8.i19.4400. The Regazzoni classification correlated with the AOFAS score (p = 0.003), MFS (p = 0.002), Rowe (p = 0.002), CNHF (p = 0.0001), FOA (p = 0.003), MFA score (p = 0.002), and VAS (p = 0.005). - this pushes up depressed parts ofsubtalar joint; Federal government websites often end in .gov or .mil. [QxMD MEDLINE Link]. Essex-Lopresti classification: It is based on fracture lines using lateral radiographical images.. Joint depression type with a single vertical fracture line through the angle of Gissane separating the anterior and posterior portions of the calcaneus. [QxMD MEDLINE Link]. 2002 Oct. 84 (10):1733-44. Lack of first rocker sagittal plane block Boehlers angle normally around 25-40 degrees if decreased ? Timothy B Dixon, MD Staff Physician, Department of Surgery, Division of Orthopedic Surgery, Scott and White Memorial Hospital. 2007;36(1):1-10. The posterior facet is a major weightbearing surface, though the anterior and middle facets bear more weight per unit area. Zwipp H, Paa L, ilka L, Amlang M, Rammelt S, Pompach M. Introduction of a New Locking Nail for Treatment of Intraarticular Calcaneal Fractures. Surgical management of calcaneal fractures. 1. 13:75-89. 1993 May. Varela CD, Vaughan TK, Carr JB, Slemmons BK. Subscribe to our e-mail newsletter to receive updates. It can show the extent and extra- or intra-articular components of the fracture and hematoma along the sole of the foot (Mondor sign). Thermann H, Krettek C, Hfner T, Schratt HE, Albrecht K, Tscherne H. Management of calcaneal fractures in adults. Mansoor AhmedBohlers angle 1) most superior aspect of the posterior facet (posterior articular surface) to the highest point of the anterior process 2) superior portion of the calcaneal tuberosity to most superior aspect of posterior facetGissanes angle 1) along the lateral border of the posterior facet 2) along the anterior process of the calcaneus. Calcaneus malunion and nonunion. [QxMD MEDLINE Link]. 2001 Jan. 32 (1):35-51, viii. 2020 May 5. [QxMD MEDLINE Link]. 60-75% of injuries are intra-articular fractures, no significant increase in infection rates, peak incidence in women in seventh decade of life, violent contaction of the triceps surae with forced dorsiflexion, strong concentric contaction of the triceps surae with knee in full extension, intrinsic tightness of the gastrocnemius and achilles tendon, peripheral neuropathy leading to decreased pain sensation and proprioception resulting in recurrent microtrauma, increased physical activity in the setting of relative energy deficiency, primary fracture line results from oblique shear and leads to the following, includes the sustentaculum tali and is stabilized by strong ligamentous and capsular attachments, dictate whether there is joint depression or tongue-type fracture, strong contraction of gastrocnemius-soleus with concomitant avulsion at its insertion site on calcaneus, more common in osteopenic/osteoporotic bone, inversion and plantar flexion of the foot cause avulsion of the bifurcate ligament, superolateral fragment contains the articular facets, superior articular surface contains three facets that articulate with the talus, the flexor hallucis longus tendon is medial to the posterior facet and inferior to the medial facet and can be injured with errant drills/screws that are too long, between the middle and posterior facets lies the, projects medially and supports the neck of talus, connects the dorsal aspect of the anterior process to the cuboid and navicular, calcaneal tuberosity (Achilles tendon avulsion), the primary fracture line runs obliquely through the posterior facet forming two fragments, the secondary fracture line runs in one of two planes, the axial plane beneath the facet exiting posteriorly in, when the superolateral fragment and posterior facet remain attached to the tuberosity posteriorly, behind the posterior facet in joint depression fractures, based on the number of articular fragments seen on the coronal CT image at the widest point of the posterior facet, One fracture line in the posterior facet (, Two fracture lines in the posterior facet (, based on fracture morphology of the calcaneus tuberosity, tenting, ecchymosis, or lack of skin blanching with tuberosity fractures, neccessitates urgent sugical reduction and fixation to avoid posterior heel skin necrosis, must be debrided and epithelialized prior to surgical intervention, lack of heel cord continuity in avulsion fractures, lack of posterior heel skin blanching with tenting fractures, assess for compartment syndrome secondary to swelling, presence of Langer's lines and skin wrinkles suggests skin is appropriate for surgical intervention, decreased ankle plantarflexion strength with avulsion fractures, assess for neuologic compromise due to swelling, severe peripheral vascular disease may preclude surgical treatment due to poor wound healing potential, useful for evaluation of intraoperative reduction of posterior facet, with ankle in neutral dorsiflexion and ~45 degrees internal rotation, take x-rays at 40, 30, 20, and 10 degrees cephalad from neutral, visualizes tuberosity fragment widening, shortening, and varus positioning, place the foot in maximal dorsiflexion and angle the x-ray beam 45 degrees, demonstrates lateral wall extrusion causing fibular impingement, indicates partial separation of facet from sustentaculum, angle between line from highest point of anterior process to highest point of posterior facet + line tangential to superior edge of tuberosity, represents collapse of the posterior facet, angle between line along lateral margin of posterior facet + line anterior to beak of calcaneus, demonstrates posterior and middle facet displacement, demonstrates calcaneocuboid joint involvement, used only to diagnose calcaneal stress fractures in the presence of normal radiographs and/or uncertain diagnosis, cast immobilization with nonweightbearing for 10 to 12 weeks, anterior process fracture involving <25% of calcaneocuboid joint, comorbidities that preclude good surgical outcome (smoker, diabetes, PVD), avoids the high wound complications seen with these fractures, minimally displaced tuberosity fractures (<1 cm of displacement) without threatened soft-tissue envelope in elderly patients with reduced function or physical capacity, begin early range of motion exercises once swelling allows, early reduction prevents skin sloughing and need for subsequent flap coverage, ideal in patients with sever peripheral vascular disease or severe soft-tissue compromise, lag screws from posterior superior tuberosity directed inferior and distal, require urgent reduction and fixation to avoid skin necrosis (disastrous consequence), open reduction allows for sufficient debridement of contaminated tissue, inability to participate in closed treatment, large extra-articular > 2 mm displacement, posterior facet displacement >2 to 3 mm, flattening of Bohler angle, or varus malalignment of the tuberosity, anterior process fracture with >25% involvement of calcaneocuboid joint, wait 10-14 days until swelling and blisters resolve and wrinkle sign present 10-14 days, no benefit to early surgery due to significant soft tissue swelling, displaced tuberosity fractures with posterior skin compromise should be addressed urgently, number of intra-articular fragments and the, surgical treatment decreases the risk of post-traumatic arthritis, age > 50 (similar outcomes with surgical and nonsurgical treatment), initial Bhler's angle <0 (these injuries do poorly regardless of treatment), lower Bhler angles suggest greater energy absorbed, open fractures (significant soft tissue injury and engery absorbed), bilateral calcaneal fractures (significant gait problems following bilateral injuries), factors associated with most likely need for a secondary subtalar fusion, male worker's compensation patient who participates in heavy labor work with an initial Bhler angle less than 0 degrees, standard short-leg cast for calcaneal stress fractures, standard short-leg cast applied with mild equinus, windowed over posterior heel to allow for frequent skin checks, requires close follow-up to determine if pull of gastrocnemius-soleus dispaces fracture, weekly cast changes are necessary due to high incidence of skin complications, high incidence of vascular insufficiency and diabetes in this population, ideal for poor soft tissue coverage or patients with peripheral vascular disease, Steinmann pin placed into the fracture site anteromedially-to-posterolateral to leverage fragments into place, additional K-wires and Steinmann pins are placed from posterior-to-anterior and lateral-to-medial to secure remaining bone fragments, calcaneal transfixin pin can be used to distract fracture, percutaneus tamps and elevators can be used to raise the articular surface, pins are cut flush with the skin and removed 8-10 weeks post-op, can be combined with distracting external fixator, pins placed in calcaneal tuberosity, cuboid, and distal tibia, restor calcaneal height, width, and alignment, can be combined with percutaneous cannulated screws, extensile lateral L-shaped incision is most popular, vertical portion inbetween posterio fibula and achilles tendon, horizontal portion in line with 5th metatarsal base, a more inferior incision protects the sural nerve, provides access to the calcaneocuboid and subtalar joints, full-thickness skin, soft tissue, and periosteal flaps are developed, lateral calcaneal branch of peroneal artery, superior flap contains the calcaneofibular ligaments and peroneal tendon sheath, sural nerve and peroneal tendons are retracted superiorly, fracture opened and medial wall reduced going medial to lateral, reduction confirmed indirectly via fluoroscopy, tuberosity reduction is done under direct visualization, manual traction, Schanz pins, and minidistractors, height and length of tuberosity is recreated, definitive fixation with plates and screws, restore Bhler's angle and calcaneal height, minimally invasive incision that minimizes soft tissue dissesction, reduces wound complications associated with extensile lateral incision, allows direct visualization of the posterior facet, anterolateral fragment, and lateral wall, same incision can be utilized for secondary subtalar arthrodesis or peroneal tendon debridement, patient placed in lateral decubitus position, incision made in line with the tip of the fibula and the base of the 4th metatarsal, extensor digitorum brevis retracted cephalad to expose sinus tarsi and posterior facet, Schanz pin inserted percutaneously in posteroinferior tuberosity going from lateral to medial, provides distraction and aids with reduction, fibrous debris and fat removed from sinus tarsi, small elevator or lamina spreader placed under posterior facet fragment to aid in reduction, K-wires inserted for provisional fixation aimed towards the sustentaculum, two screw are placed lateral-to-medial to engage sustentaculum and support facet, one large fully threaded screw from posterior-to-anterior to support axial length of calcaneus, low-profile plate is applied underneath a well developed soft tissue envelope with screws engaging anterolateral and tuberosity fragments, nonweight bearing for 6-8 weeks post-op with ankle range-of-motion exercises beginning 2 weeks post-op, manipulate the heel to increase the calcaneal varus deformity, manipulate the heel to correct the varus deformity with a valgus reduction, stabilize the reduction with percutaneous K-wires or open fixation as described above, arthroscopic-assisted reduction and internal fixation, improved visualization of articular surface and carilage lesions, increased swelling from fluid extravasation, can be combined with sinus tarsi approach, patient positioned in lateral decubitus position, fluoroscopy unit positioned posterior and oblique to patient, anterolateral and posterolateral portals are used to visualize posterior facet, loose bodies and cartilage fragments are removed with a shaver, Freer elevator is introduced into one of the portal sites and used to elevate the posterior facet, Schanz pin to control tuberosity fragment, cannulated screws from the posterior aspect of the calcaneal tuberosity to the anterior aspect of the calcaneus, lateral-to-medial screws placed in sustentaculum, buttress screw from the posterior aspect of the calcaneal tuberosity to the subchondral bone of the posterior facet, posterior approach for calcaneal tuberosity fractures, fracture fragment is mobilized and debrided, plantar flexion of foot aids with reduction, presence of gastrocnemius tightness may preclude reduction, Strayer procedure may be performed to aid in reduction, figure-of-8 tension-band wire passed around ends of K-wires or cannulated screws, Krackow sutures passing through bone tunnels, restricted weight bearing for 6 weeks followed by progression of weight bearing an additional 6 weeks, performed in highly comminuted Sanders IV intraarticular fractures, high rate of secondary fusion after ORIF with these injuries, avoids added treatment costs and decreases time off from work, can be performed through an extensile lateral or sinus tarsi approach, fracture reduction is perfromed in a similar fashion as ORIF, articular cartilage of the subtalar joint denuded to bleeding subchondral bone, cannulated compression screws are placed from the posterio calcaneal tuberosity to the talar dome, lateral fixation plate applied to hold reduction, increased risk in smokers, diabetics, and open injuries, may consider nonoperative treatment in these patients, tongue type fractures at high risk (>20%) for posterior skin necrosis, should be splinted in 30 degrees of planarflexion to relieve soft tissue tension, keep all hardware away from the corner of the incision, delayed wound healing is the most common complication, can be addressed with ankle bracing (gauntlet type), NSAIDs, injections, and physical therapy, may require bone block subtalar arthrodesis to address loss of calcaneal height, important when there are symptoms of anterior ankle impingement, Lateral impingement with peroneal irritation, at risk with placement of lateral to medial screws, especially at level of sustentaculum tali (constant fragment), loss of height, widening, and lateral impingement, distraction bone block subtalar arthrodesis, incongruous subtalar joint/post-traumatic DJD, results from posterior talar collapse into the posterior calcaneus, Lateral exostosis with no subtalar arthritis, Lateral exostosis with subtalar arthritis, Lateral exostosis, subtalar arthritis, and varus malunion, increased due to mechanism (fall from height), smoking, and early surgery, lateral soft tissue trauma increases the rate of complication, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries.