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Foot Pathology: Calcaneal fractures

The calcaneus is the most commonly fractured tarsal bone. Calcaneal fractures are classified as intraarticular and extraarticular. The intraarticular fracturesaccount for 70-75% of calcaneal fractures and carry a worse prognosis. The inciting trauma is usually a fall or motor vehicle accident, and these fractures are bilateral in 10% of cases. Concomitant ipsilateral lower extremity fractures are present in 20-46% of cases, and spinal fractures in 10-30%. Extrarticular fractures (Figure: extraarticular fracture of calcaneus) account for 25-30% of calcaneal fractures, and are the sequela of a twisting injury. Anatomic regions affected include the anterior or medial process, the sustentaculum tali, the body or the tuberosity. Severe fractures are readily evident on conventional radiographs; however, CT is essential for elucidating the extent of injury. The intraarticulur fractures are often comminuted and may be displaced. CT is also used for follow up after fracture treatment. CT is very helpful for detecting fracture malunion or nonunion . In addition, the presence and extent of secondary osteoarthritis is readily detected by CT. Several features of intraarticular fractures which can be elucidated on CT have been shown to correlate with the outcome. A central depression fracture has a worse prognosis than a tongue-type fractures, but a better prognosis than a comminuted fracture. An unsatisfactory result is more likely in the setting of subtalar incongruity, decreased fibulocalcaneal space and osteoarthrosis of the talonavicular joint and the ankle.

Clinical History: 31 year old male who injured both lower extremities. Radiographs revealed a left tibial pylon fracture and right calcaneal fracture.

CT Findings: Comminuted fracture of the right calcaneus. No dislocation. Minimal loss of calcaneal height.

Diagnosis: Fracture of the calcaneus.

 
 
Clinical History: Fracture related to jumping out of a window.

CT Findings: CT scan demonstrates fracture of the mid-third of the calcaneus.

Diagnosis: Calcaneal fracture.

Comments: The patient was difficult to treat as the patient was a psychiatric patient with seizures and bipolar disorder.

 
 

Clinical History: This injury was the result of a motor vehicle accident where the patient was a passenger.

CT Findings: CT scanning demonstrates a comminuted fracture of the calcaneus involving all three components of the calcaneus wit loss of height of the anterior portion of the calcaneus.

Diagnosis: Fracture of the calcaneus.

 
 

Diagnosis: Calcaneal fracture.

 
 

Diagnosis: Calcaneal fracture.

 
 

Diagnosis: Calcaneal fracture.

 
 

Diagnosis: Calcaneal fracture.

 
 

Diagnosis: Calcaneal fracture.

 
 

Diagnosis: Calcaneal fracture.

 
 

Diagnosis: Calcaneal fracture.

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