Abstract. Grainger & Allison's Diagnostic Radiology Essentials E-Book. - Sub-Talar Joint PMC - The management of soft-tissue problems associated with calcaneal fractures. Dr. Wheeless enjoys and performs all types of orthopaedic surgery but is renowned for his expertise in total joint arthroplasty (Hip and Knee replacement) as well as complex joint infections. As you move from type 1 to type 4 injuries, expected outcomes are progressively worse. - may also use lateral pin to manipulate the fracture fragments; - spinal compression frx; -cannulated screw: inserted from latearal to medial into the sustentaculum tali; The mechanism of injury in calcaneus fractures typically involves a high-energy axial load applied to the heel, which drives the talus downward onto the calcaneus. Results of closed treatment, Operative Versus Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures, Age, Gender, Work Capability, and Worker's Compensation in Patients with Displaced Intraarticular Calcaneal Fractures, Primary Subtalar Fusion for Calcaneal Fracture, Treatment of Displaced Intra-Articular Calcaneal Fractures with Closed Reduction and Percutaneous Screw Fixation, Intra-Articular Fractures of the Calcaneus. Percutaneous Cannulated Screw Fixation vs. Plating With Minimally Invasive Longitudinal Approach After Closed Reduction for Intra-Articular Tongue-Type Calcaneal Fractures: A Retrospective Cohort Study. The classification of extraarticular fractures has been less controversial and makes use of anatomic landmarks on the calcaneus to divide the bone into anterior, middle, and posterior areas. Int Orthop. Calcaneal fractures have been treated by closed methods since the time of Hippocrates. document.write ("?zoneid=188"); 1993 May. 14:290. Type III (20%) are oblique fractures. - Rowe: types 1-5 (types 4-5 intra-articular) 12 (1):125-35. - primary frx line: - most of these involve the posterior facet (but can involve anterior and middle facets); A prospective study, Intraarticular calcaneal fractures. 1992. The body of the calcaneus is composed primarily of cancellous bone, having a comparatively thin cortex. Objective The aim of this study was to correlate the functional outcome after treatment for displaced intra-articular calcaneal fracture with plain radiography. Foot Ankle Int. - in patients that performed heavy work: 46 (3):615-621. Epub 2020 Oct 27. Medscape Education. [QxMD MEDLINE Link]. Type 3. Aditya Daftary et.al. Orthop Clin North Am. Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome. - joint depression calcaneal fracture. -Bruce Ziran/P. Shekhbihi A, Shahat A, Riem S, Reichert W, Masoud M. J Orthop. [QxMD MEDLINE Link]. Interventions for treating calcaneal fractures. Fractures of the calcaneus, or os calcis, have been observed and documented for centuries. - associated injuries: 64 (4):519-24. 3. Percutaneous reduction and fixation of displaced intra-articular calcaneus fractures. Minimally invasive arthroscopic-assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases. If bilateral calcaneal fractures are seen, then the spine should also be evaluated for fracture as the mechanism of injury is often a large load to the axial skeleton, such as a fall from height. 2. Inversion, lateral tuberosity. 2006 May. [QxMD MEDLINE Link]. Rowe Calcaneal Fracture - Radiology and Biomechanics 7,462 views Sep 13, 2014 Mansoor Ahmed Show more 114 Dislike Share ahMEDacademy 3.54K subscribers Myerson classification - LisFranc. [21] Whereas the minimally invasive approach resulted in a lower postoperative complication rate for Sanders type II and III injuries, functional outcomes were similar. Check for errors and try again. Please enable it to take advantage of the complete set of features! (3) 1. J Orthop Trauma. Type 1B Sustentaculum tali fracture The poor correlation of these comprehensive classification systems with functional outcomes hindered their widespread acceptance. Surgery Coughlin MJ, Saltzman CL, Anderson RB, eds. Front Surg. Cotton FJ, Henderson FF. Foot Ankle Int. [QxMD MEDLINE Link]. Type II or beak fractures are uncommon. Is Bone Mineral Density Testing Underused in Prostate Cancer Care? Sanders R, Fortin P, DiPasquale T et-al. Dhillon MS, Gahlot N, Satyaprakash S, Kanojia RK. The French surgeon described two types of fracture mechanisms: an avulsion injury resulting from muscular pull and a crushing injury. Schepers T, van Lieshout EM, Ginai AZ, Mulder PG, Heetveld MJ, Patka P. J Foot Ankle Surg. Sustentaculum tali fractures are rarely seen as isolated injuries. Type 2B Posterior beak fracture (achilles involvement) 4. Epub 2013 Oct 28. - Discussion: 2014 Feb 19. Grn W, Molund M, Nilsen F, Stdle AH. Part I: Pathological anatomy and classification, Mechanism and pathoanatomy of the intraarticular calcaneal fracture, Fractures of the calcaneum: the anterolateral fragment, Computed tomographic assessment of soft tissue abnormalities following calcaneal fractures, Magnetic resonance imaging evaluation of calcaneal fat pads in patients with os calcis fractures, Intra-articular fractures of the calcaneus: Present state of the art, Intra-articular fractures of the calcaneus, Fractures of the calcaneus: open reduction and internal fixation from the medial side a 21-year prospective study, Operative Compared with Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures. [QxMD MEDLINE Link]. Scott Nicklebur, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of PhysiciansDisclosure: Nothing to disclose. Skeletal Trauma. FOIA Philadelphia: Elsevier Saunders; 2014. 20 (2):168-75. Type 3 Extra-articular fracture of body Limited subtalar joint range of motion 9:854210. [QxMD MEDLINE Link]. The .gov means its official. Public Health 2018 Sep. 39 (9):1106-1112. Yu S & Yu J. Calcaneal Avulsion Fractures: An Often Forgotten Diagnosis. Eversion, medial tuberosity is injured. - Sander's Classification: 2022. Use coronal image with the widest undersurface of the posterior facet of the talus. [QxMD MEDLINE Link]. 2016 Mar. [QxMD MEDLINE Link]. Intra-articular fractures may be treated in a closed fashion but are more commonly treated with a combination of open reduction, ostectomy, osteotomy, internal fixation, and/or arthrodesis of the subtalar and calcaneocuboid joints. Walde TA, Sauer B, Degreif J, Walde HJ. Telephone: 410.494.4994, Displacement of the Sustentacular Fragment in Intra-Articular Calcaneal Fractures, The management of soft-tissue problems associated with calcaneal fractures, Compartment syndrome of the foot after intraarticular calcaneal fracture. [QxMD MEDLINE Link]. Browner BD, Jupiter JB, Krettek C, Anderson PA, eds. The need for preoperative, or screening, laboratory studies usually depends on the extent of other injuries and the presence of comorbid medical conditions. Broden B. Roentgen examination of the subtaloid joint in fractures of the calcaneus. Data Trace specializes in Legal and Medical Publishing, Risk Management Programs, Continuing Education and Association Management. Besch L, Waldschmidt JS, Daniels-Wredenhagen M, Varoga D, Mueller M, Hilgert RE, et al. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Cochrane Database Syst Rev. Buckley RE, Meek RN. Case 8: calcaneal anterior process fracture, Case 9: extra-articular calcaneal fracture, Case 12: anterior calcaneal process fracture, see full revision history and disclosures, Gustilo Anderson classification (compound fracture), Anderson and Montesano classification of occipital condyle fractures, Traynelis classification of atlanto-occipital dissociation, longitudinal versus transverse petrous temporal bone fracture, naso-orbitoethmoid (NOE) complex fracture, cervical spine fracture classification systems, AO classification of upper cervical injuries, subaxial cervical spine injury classification (SLIC), thoracolumbar spinal fracture classification systems, AO classification of thoracolumbar injuries, thoracolumbar injury classification and severity score (TLICS), Rockwood classification (acromioclavicular joint injury), Neer classification (proximal humeral fracture), AO classification (proximal humeral fracture), AO/OTA classification of distal humeral fractures, Milch classification (lateral humeral condyle fracture), Weiss classification (lateral humeral condyle fracture), Bado classification of Monteggia fracture-dislocations (radius-ulna), Mason classification (radial head fracture), Frykman classification (distal radial fracture), Hintermann classification (gamekeeper's thumb), Eaton classification (volar plate avulsion injury), Keifhaber-Stern classification (volar plate avulsion injury), Judet and Letournel classification (acetabular fracture), Harris classification (acetebular fracture), Young and Burgess classification of pelvic ring fractures, Pipkin classification (femoral head fracture), American Academy of Orthopedic Surgeons classification (periprosthetic hip fracture), Cooke and Newman classification (periprosthetic hip fracture), Johansson classification (periprosthetic hip fracture), Vancouver classification (periprosthetic hip fracture), Winquist classification (femoral shaft fracture), Schatzker classification (tibial plateau fracture), AO classification of distal femur fractures, Lauge-Hansen classification (ankle injury), Danis-Weber classification (ankle fracture), Berndt and Harty classification (osteochondral lesions of the talus), Sanders CT classification (calcaneal fracture), Hawkins classification (talar neck fracture), anterior superior iliac spine (ASIS) avulsion, anterior cruciate ligament avulsion fracture, posterior cruciate ligament avulsion fracture, avulsion fracture of the proximal 5th metatarsal, 1. [QxMD MEDLINE Link]. Carpenter BB, Butterworth ML, Fishco WD, Marcoux JT, eds. ADVERTISEMENT: Supporters see fewer/no ads. Acta Biomed. 2020 Jun. Calcaneus fractures. Podiatrists Mean postoperative pain score on the Visual Analogue Scale (VAS) was 1.6. This site needs JavaScript to work properly. Data Trace is the publisher of [9, 10, 11] Only with the advent of computed tomography (CT) was the capability to evaluate accurately complex calcaneus injuries realized. Oper Orthop Traumatol. It can show the extent and extra- or intra-articular components of the fracture and hematoma along the sole of the foot (Mondor sign). Avulsion-type fracture of calcaneus, sustained when patient fell 6 ft from ladder onto solid ground. NoYes Bone Defects After Surgery for Displaced Intraarticular Calcaneal Fractures Spontaneously Improve Without Bone Grafting. [CDATA[ Plast Reconstr Surg. Bilateral calcaneus fractures sustained in motor vehicle collision. At the time the article was created Matt Skalski had no recorded disclosures. At the time the article was created The Radswiki had no recorded disclosures. Subscribe to our e-mail newsletter to receive updates. Degan TJ, Morrey BF, Braun DP. A complete blood count (CBC), blood. fracture of the anterior tubercle due to plantarflexion on a supinated foot Most common type 1 fracture Most common in females Tx: CR and BK WB cast for 6 weeks. government site. Thermann H, Krettek C, Hfner T, Schratt HE, Albrecht K, Tscherne H. Management of calcaneal fractures in adults. 2002 Oct. 23 (10):906-16. 2020 Jul. J Bone Joint Surg Am. Patients filled in . [QxMD MEDLINE Link]. Type 4 Intra-articular fracture of body without collapse/depression Calcaneal fracture classification: a comparative study. 2009 May-Jun. - Primary Subtalar Fusion for Calcaneal Fracture, - Percutaneous Fixation: 12. Patients A total of 33 patients with a unilateral calcaneal fracture and a minimum follow-up of 13 months participated. - may be indicated for patients with inadequate soft tissues (diabetics with frx blisters) where risk of dehissence is high; - tongue fracture Teaching & Learning 2012 Sep;33(9):727-33. doi: 10.3113/FAI.2012.0727. [QxMD MEDLINE Link]. 1) Beak type - tuberosity fragment tilts into varus and is pulled proximally by the Achilles tendon; Wheeless' Textbook of Orthopaedics. Juliano P, Nguyen HV. [QxMD MEDLINE Link]. 2023 Lineage Medical, Inc. All rights reserved, avulsion injury of the bifurcate ligament, in-situ arthrodesis with preserved calcaneal height, Calcaneal Fracture ORIF with Lateral Approach, Plate Fixation, and Locking Screws. 2021 Oct;141(10):1691-1699. doi: 10.1007/s00402-020-03649-3. Magnetic resonance imaging evaluation of calcaneal fat pads in patients with os calcis fractures. The Essex-Lopresti classification showed no statistically significant relation with any of the clinical scores (p > 0.05). Essex-Lopresti describedthe following twocalcaneus fracture subtypes 1993 May. This fracture fragment contains most of the posterior facet. Treatment is nonoperative versus operative based on fracture displacement and alignment, associated soft tissue injury, and patient risk factors. - Compartment syndrome of the foot after intraarticular calcaneal fracture. JAMA. James K DeOrio, MD Professor of Orthopedics, Director, Duke Foot and Ankle Fellowship, Duke University Medical Center, Duke University School of Medicine; Associate Professor, Mayo Clinic College of Medicine; Clinical Assistant Professor, F Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences Crosby LA, Fitzgibbons T. Intraarticular calcaneal fractures. The subtalar joint is involved 75% of the time. Foot Ankle Int. 1. Curr Rev Musculoskelet Med. - ORIF using lateral approach: Treatment of open intra-articular calcaneal fractures: evaluation of a treatment protocol based on wound location and size. ROWE CLASSICATION FOR CALCANEAL FRACTURE Flashcards by Nicholas de Guzman | Brainscape Brainscape Find Flashcards Why It Works Educators 60 (6):546-551. Before Vol 2: 1297-1340. Grant, Nyree Griffin. Patient Assessment and Examination - threaded Steinman pin is inserted through the posterior inferior corner of the calcaneus, across posterior facet and into the talar body; The calcaneus functions as a lever arm for the gastrocsoleus complex, providing a foundation or. Positive factors for prognosis of calcaneal fractures? Zhong L, Xu Y, Wang Y, Liu Y, Huang Q. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. You are being redirected to 1993. At the time the article was last revised Sonam Vadera had In the more frequent joint-depression fracture, the secondary fracture line begins at the angle of Gissane and extends posteriorly but deviates dorsally to exit the bone just posterior to the posterior articular facet. type A fractures: the anterior process of the calcaneus is fractured, type B: fracture of the mid calcaneus, trochlear process, and sustentaculum tali, type C:fracture of the posterior tuberosity, ADVERTISEMENT: Supporters see fewer/no ads. Treatment: Compare minimally displaced calcaneal tuberosity fracture on patient's left side with comminuted intra-articular (Sanders type III) fracture on right. 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 . Ten percent of calcaneus fractures are bilateral. [QxMD MEDLINE Link]. Often non-displaced because of extensive ST attachmentRowe 1b sustentaculum tali, inversion Rowe 1c anterior process. Skeletal Trauma: Basic Science, Management, and Reconstruction. Calcaneal fracturesare the most common tarsal fracture and can occur in a variety of settings. Surgical management of calcaneal fractures. Foot Orthotics Foot Ankle Int. The results of this study did not lend support to the view that ORIFyields better outcomes than conservative therapy for these fractures. 2022 Mar. Calcaneus malunion and nonunion. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Rammelt S, Sangeorzan BJ, Swords MP. The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2 and ~60% of all tarsal fractures . Operative Compared with Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures. Acta Radiol. The sinus tarsi approach yielded statistically significant improvements in functional outcomes over the minimally invasive approach, but this was limited to patients with Sanders type IV injuries. [QxMD MEDLINE Link]. 1982 Apr. J Bone Joint Surg Am. Myerson MS, ed. Compared to radiological based classifications, the CT based classifications, especially the Regazzoni and Sanders classifications, exhibited higher prognostic value compared to ultimate outcome scores. [QxMD MEDLINE Link]. 1) avulsion due to pull of bifurcate ligament or EDB muscle, supination 2) compressive, pronated Rowe 2a Beak fracture, land on heel with knee extended and foot dorsiflexedRowe 2b avulsion of the entire insertion of the Achilles, older patients with DM and osteoporosis Rowe 3a simple body fracture, STJ not fractured or depressed Rowe 3b comminuted body fracture, STJ not fractured or depressedIf the posterior facet is not involved, usually closed reduction with cast immobilization for six weeks is good.Rowe 4a simple body fracture, STJ fracture, but not depressedRowe 4b comminuted body fracture, STJ fracture, but not depressedRowe 5a comminuted body fracture, STJ fracture, and STJ depressionRowe 5b comminuted body fracture, STJ fracture, STJ depression, CC joint fracture If an intra-articular calcaneal fracture is seen, the images should be scrutinized for a lateral malleolar fleck sign (ankle), which raises the likelihood of peroneal tendon instability 10. Results of closed treatment. Type 5 Intra-articular fracture of body with collapse/depression, Essex-Lopresti Classification (most widely used): Twelve observers classified 30 intra-articular calcaneal fractures . Cotton commented in 1916 that "the man who breaks his heel bone is done so far as his industrial future is concerned." - Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome. Podiatry Schools & Programs Materials and methods: For 152 patients (189 calcaneal fractures; average followup, 9.9 years), all fractures were classified in accordance with the Essex-Lopresti, OTA, Regazzoni, and Sanders classifications and matched with the following scores: AOFAS score, CNHF, FOA, MFS, Rowe, MFA, SF-36, and VAS. var m3_r = Math.floor(Math.random()*99999999999); Calcaneal fractures are the most common tarsal fracture and can occur in a variety of settings. Imaging This classification is based on the number of intraarticular fracture lines and their location on semicoronal CT images. Orthopaedics Bethesda, MD 20894, Web Policies Background: Philadelphia: Saunders; 2000. - compartment syndrome deep central compartment is involved most often in calcaneal frx; Intra-articular fractures constitute 70% of all calcaneus fractures in adults. Rowe Classification: Types I-III do not involve the subtalar joint. Extra-articular fractures, with some exceptions, are generally treated in a closed manner. 2008 Jun. [QxMD MEDLINE Link]. [15, 16] Prospective studies have attempted to show benefit either with early operative intervention or with nonoperative measures. There are, however, several important areas of increased bony density that are particularly amenable to screw placement, including the following: The tibial artery, nerve, posterior tibial tendon, and flexor hallucis longus tendon course along the medial wall of the calcaneus, though they are rarely damaged in calcaneus fractures caused by blunt force. Unable to process the form. The Bhler and Gissane angles are used to assess the severity of calcaneal fractures, and their postoperative appearance is correlated with functional outcomes 12. Advances in cross-sectional imaging, particularly in computed tomography (CT), have given this modality an important role in identifying and characterizing calcaneal fractures. [QxMD MEDLINE Link]. Calcaneus fractures. Widening of heel [Full Text]. It is from this point that multiple secondary fracture lines may develop. 2001 Jan. 32 (1):35-51, viii. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Foot Ankle Orthop. Part I: Pathological anatomy and classification. Zwipp H, Paa L, ilka L, Amlang M, Rammelt S, Pompach M. Introduction of a New Locking Nail for Treatment of Intraarticular Calcaneal Fractures. (See Ankle Joint Anatomy.). - Closed reduction and percutaneous pinning for comminuted intra-articular fractures of the calcaneus: Preliminary results. 2007;36(1):1-10. 4) With comminution from below Osteoarthritis of STJ 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 He founded Orthopaedic Specialists of North Carolina in 2001 and practices at Franklin Regional Medical Center and Duke Raleigh Hospital. Towson, MD 21204 Journals Comparing different types of calcaneal fractures, associated treatment options, and outcome data is currently hampered by the lack of consensus regarding fracture classification. 2000. Clifford R. Wheeless, III, M.D. Conclusion: - typically results from fall from height (see mechanism) A critical analysis of results and prognostic factors. 2008 Jun. - anteromedial (sustentacular) frag is rarely comminuted but varies in size; 184:920-923. Rubino R, Valderrabano V, Sutter PM, Regazzoni P. Prognostic value of four classifications of calcaneal fractures. 6 (2):252-65. 66 (3):386-90. The most common extra-articular fracture is a calcaneal body fracture. 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 Twelve observers classified 30 intra-articular calcaneal fractures according to the 3 most prevalent classification systems; interobserver reliability (kappa [kappa] statistic) and the. [ 31] Exceptions to this rule include open. Calcaneus fractures are rarely encountered as open fractures. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2022 Sep 29;34:357-363. doi: 10.1016/j.jor.2022.09.016. 3) Vertical Norris correctly described a compression mechanism in calcaneus fractures in 1839, and in 1843, Malgaigne described two types of calcaneal fractures; this description formed the first. Learn faster with spaced repetition. Intra-articular fractures of the calcaneus: Present state of the art. - Non operative treatment: A frustrating factor that perpetuates this disagreement is the subset of calcaneus fractures with poor long-term outcomes, regardless of management. A prospective study. Treatment of severe fractures of the calcaneus by reconstruction arthrodesis using the Vira System: Prospective study of the first 37 cases with over 1 year follow-up. 1949. Local administration of epsilon-aminocaproic acid reduces post-operative blood loss from surgery for closed, Sanders III-IV calcaneal fractures. Complications (eg, malunion or screw positioning deviation) occurred in six patients and delayed wound healing in one. (2):CD001161. Pharmacology Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-12879, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":12879,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/calcaneal-fracture/questions/2122?lang=us"}. Chen et al investigated a combination of minimally invasive dual incision and internal fixation with mini plates as an alternative to ORIF in 20 patients with Sanders type III intra-articular calcaneal fractures and a posterior subtalar articular displacement greater than 2 mm. Barei DP, Bellabarba C, Sangeorzan BJ, Benirschke SK. Background: Sinus tarsi approach and mini-calc plate have been used for intra-articular calcaneal fractures. Results After Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures. 31:85. (2018) ISBN: 9780323568845 -. Disclaimer. Results of closed treatment. Comparison of open versus closed reduction of intraarticular calcaneal fractures: a matched cohort in workmen. if (document.context) document.write ("&context=" + escape(document.context)); 39 (4):443-449. For 152 patients (189 calcaneal fractures; average followup, 9.9 years), all fractures were classified in accordance with the Essex-Lopresti, OTA, Regazzoni, and Sanders classifications and matched with the following scores: AOFAS score, CNHF, FOA, MFS, Rowe, MFA, SF-36, and VAS. Fractures of the os calcis. Nearly all intra-articular fractures of the calcaneus are caused by an axial loading mechanism, which is directed through the laterally situated (in relation to the weightbearing axis of the lower extremity) plantar tuberosity of the calcaneus. Essex-Lopresti P. The mechanism, reduction technique, and results in fractures of the os calcis, 1951-52. 2014 Feb;35(2):156-62. doi: 10.1177/1071100713509804. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Disruption of this angle is due to lateral process of talus driving through calcaneusThe goal of treatment is often to re-establish the articular alignment, meaning the posterior facet.Rowe 1a plantar tuberosity. - vasculopath: 1963. 2005;25(5):1215-26. Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures. Pozo JL, Kirwan EO, Jackson AM. 15 (1):167. [QxMD MEDLINE Link]. Selim A, Ponugoti N, Chandrashekar S. Systematic Review of Operative vs Nonoperative Treatment of Displaced Intraarticular Calcaneal Fractures. Orthop Clin North Am. 52 (3):239-243. Type I (20%) the fracture line may be through the tuberosity, the sustentaculum tali, or the anterior process of the calcaneus. - historical treatment has included closed reduction (Bohler) w/ distraction and medial lateral compression; [QxMD MEDLINE Link]. Conservative versus operative treatment. Open injuries that have been reported have occurred in only 2% of cases. Mechanism and pathoanatomy of the intraarticular calcaneal fracture. The resultant primary fracture line extends from the lateral aspect of the angle of Gissane in a posteromedial direction, initiating an oblique, primary fracture line. 4. Grala et al reported ontwo groups of patients who underwent operative treatment for articular fractures of the calcaneus, one (n = 23) treated by standard reconstruction and the other (n = 19) treated with a large bone distractor.
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