Calcaneal Fractures Quiz

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following is NOT a consistent feature directly associated with intra-articular calcaneal fractures as described?

The anterior process of the calcaneus exhibits a dorsal translation.

The calcaneal tuberosity rotates into varus and shortens.

The sustentaculum tali maintains its connection to the talus.

The calcaneal tuberosity displaces inferiorly. (correct)

According to the provided information on non-operative treatment outcomes, what percentage of patients demonstrated good or excellent results at the 20 year follow up using the Iowa Calcaneal Scale?

37%

47% (correct)

63%

53%

In the initial management of non-operative treatment for calcaneal fractures, what is typically used as a compressive dressing under a posterior splint?

A fiberglass cast

A bulky Jones type dressing (correct)

A standard elastic bandage

A soft, padded dressing

Which of the following is NOT typically an indication for operative treatment of calcaneal fractures?

Fractures with less than 20% involvement of the calcaneocuboid joint (A) Signup and view all the answers

What is the recommended time frame to delay surgery post calcaneal fracture injury to allow for reduction of swelling and rest of soft tissues?

2 to 3 weeks (A) Signup and view all the answers

What percentage of all fractures do calcaneal fractures represent?

2% (A) Signup and view all the answers

Which of the following best describes the typical patient demographic for calcaneal fractures?

Young male laborers aged 21-45 (C) Signup and view all the answers

Besides the subtalar joint, How many articulations does the calcaneus have with adjacent tarsal bones?

Three (C) Signup and view all the answers

Which structure serves as the site of insertion for the tibiocalcaneal component of the deltoid ligament?

Sustentaculum Tali (D) Signup and view all the answers

Which of the following best describes the orientation of the posterior facet of the calcaneus?

Slopes downwards from lateral to medial (C) Signup and view all the answers

What is the primary functional role of the calcaneus in relation to the plantar fascia, tendons, and ligaments?

To counteract compressive forces during weight bearing (B) Signup and view all the answers

Besides the subtalar joint, which facets of the calcaneus articulate with the talus?

Anterior, Middle, and Posterior (A) Signup and view all the answers

Which of the following best represents the proportion of tarsal fractures that are calcaneal fractures?

60% (B) Signup and view all the answers

Which of the following is NOT a primary morphological concern when addressing calcaneal fractures?

Height (B) Signup and view all the answers

Articular incongruity following a calcaneal fracture primarily involves which joints?

Subtalar and Calcaneocuboid (A) Signup and view all the answers

What is the typical initial post-operative protocol regarding weight bearing after calcaneal fracture surgery?

Non-weight bearing for 2-3 weeks in a splint (C) Signup and view all the answers

What is considered the number one predictor of poor outcome from calcaneus fracture?

Stiffness (D) Signup and view all the answers

Which of the following is stated as a benefit of minimally invasive approaches to calcaneal fracture fixation, when compared to traditional extensile approaches?

Reduction in stiffness (A) Signup and view all the answers

During a traditional lateral extensile approach for a calcaneal fracture, which structure is NOT typically included within the skin flap?

Tibial nerve (C) Signup and view all the answers

What is the primary goal when addressing the 'shortening' deformity of a calcaneal fracture?

Restore the original height and length (A) Signup and view all the answers

Which of the following is an indication for using the sinus tarsi approach for calcaneal fracture fixation?

Minimal calcaneocuboid involvement (D) Signup and view all the answers

Besides the calcaneocuboid joint, which other articulation is a primary concern for articular incongruity in calcaneal fractures?

Subtalar joint (D) Signup and view all the answers

What key feature is intended to be corrected by addressing the 'shortening' component of a calcaneal fracture?

Restoring the height and length (A) Signup and view all the answers

During reduction of a calcaneal fracture, moving the tuberosity fragment medially will correct which deformity?

Width (B) Signup and view all the answers

What is the primary soft tissue complication specifically mentioned as significant in calcaneal fractures?

Soft tissue healing problems (C) Signup and view all the answers

What is the primary approach to indirectly reduce the sustentaculum tali during calcaneal fracture fixation?

Reduction of the tuberosity (A) Signup and view all the answers

Which of the following is NOT used for K-wire retraction during the traditional lateral extensile approach?

Calcaneal tuberosity (B) Signup and view all the answers

In the context of calcaneal fracture reduction, what does addressing 'varus' primarily involve?

Restoring the valgus alignment (C) Signup and view all the answers

A surgeon is correcting the morphology of a calcaneal fracture. What are the main aspects of morphology they need to consider?

Width and varus (B) Signup and view all the answers

Which of the following best describes the 'double density' sign seen in calcaneal fractures?

Overlapping bone densities due to displaced fracture fragments. (D) Signup and view all the answers

A decrease in Böhler's angle on a lateral radiograph of the calcaneus suggests:

Displacement of the weight-bearing posterior facet. (D) Signup and view all the answers

Which anatomical issue is addressed by the 'Joint Depression-Sinus tarsi Approach'?

Deformities related to morphology, shortening, and articular incongruity (A) Signup and view all the answers

What is the typical range for the critical angle of Gissane?

95 to 105 degrees (C) Signup and view all the answers

In the Essex-Lopresti classification, what main anatomical feature are we primarily assessing?

The intra-articular fracture pattern of the calcaneus. (D) Signup and view all the answers

When considering 'morphology' during a 'Joint Depression-Sinus tarsi Approach', which specific aspects are targeted for correction?

Width and varus of the foot (C) Signup and view all the answers

The Harris Beath axial view of the calcaneus is best for assessing which of the following?

Disruption of the articular surface, heel width, and tuberosity angulation. (C) Signup and view all the answers

In the context of the 'Joint Depression-Sinus tarsi Approach', what does 'articular incongruity' refer to?

Issues with the subtalar and calcaneocuboid joints (C) Signup and view all the answers

In Broden's views, what degree of internal rotation of the leg is required when taking x-rays?

30 degrees (B) Signup and view all the answers

What is the immediate post-operative weight-bearing protocol following the 'Joint Depression-Sinus tarsi Approach'?

Non-weight bearing for 2-3 weeks in a splint (D) Signup and view all the answers

After the initial non-weight bearing period with a splint, what is the following phase of rehabilitation?

Weight bearing boot for about 8 weeks/ROM (C) Signup and view all the answers

According to the Sanders classification, a Type 3AC fracture indicates:

A lateral and medial fracture line involving the posterior facet. (D) Signup and view all the answers

Which type of fixation is explicitly mentioned as being used in conjunction with the corrections?

Percutaneous fixation (A) Signup and view all the answers

What does the Sanders classification utilize to categorize calcaneal joint depression fractures?

Coronal CT image of the posterior facet (B) Signup and view all the answers

What specific Sanders classification is referenced when using 'Percutaneous Fixation'?

Sanders 2C (A) Signup and view all the answers

Besides correcting deformities in morphology and shortening, which other primary aspect is addressed?

Articular incongruity (A) Signup and view all the answers

According to the Rowe classification, a fracture of the sustentaculum tali is classified as which type?

Type Ib (D) Signup and view all the answers

In the management of calcaneal fractures using percutaneous reduction with ring fixation, which of the following is explicitly stated as being not a primary concern?

Soft tissue injury (D) Signup and view all the answers

Which of the following Rowe classifications describes a fracture that spares the Achilles tendon insertion?

Type IIa (A) Signup and view all the answers

A patient has a calcaneal fracture resulting from a twisting fall on a supinated foot. Based on the Rowe classification, which specific injury is MOST likely suspected?

Fracture of the sustentaculum tali (C) Signup and view all the answers

According to the goals for calcaneal fracture surgery as stated in the provided text, which of the following is a primary objective?

Anatomical reduction of the calcaneus (A) Signup and view all the answers

During a traditional lateral extensile approach, which anatomical structure is NOT directly retracted using K-wires?

Sural nerve (A) Signup and view all the answers

Which of the following Rowe classifications is most commonly associated with a fall from height with the heel in a varus or valgus position, NOT involving the subtalar joint?

Type III (C) Signup and view all the answers

When correcting for 'shortening' in a calcaneal fracture, which specific dimensional aspects are addressed?

Height and Length (A) Signup and view all the answers

According to the provided surgical technique using ring fixation, what is the primary goal of distracting the joints?

To limit the weight bearing stresses on the subtalar joint (C) Signup and view all the answers

A fracture involving the Achilles tendon insertion is MOST likely classified as which of the following according to the Rowe classification?

Type II b (A) Signup and view all the answers

In addressing the tuberosity fragment of a calcaneal fracture. Which of the following is specifically corrected by moving the fragment medially?

Width (D) Signup and view all the answers

What is the primary objective of correcting the 'varus' deformity in calcaneal fracture reduction?

Re-establishing valgus alignment (B) Signup and view all the answers

Which anatomical structure is indirectly reduced during calcaneal fracture management, according to the provided text?

Sustentaculum tali (D) Signup and view all the answers

During the lateral extensile approach, the skin flap contains specific anatomical structures. Which of the following is NOT typically included in this flap?

Tibiotalar ligament (B) Signup and view all the answers

What is the primary concern associated with 'articular incongruity' following a calcaneal fracture, as outlined in the provided text?

Subtalar and Calcaneocuboid joint alignment (B) Signup and view all the answers

Besides 'shortening' and 'morphology', what other primary aspect is necessary to correct when addressing a calcaneal fracture.

Articular Incongruity (D) Signup and view all the answers

Which of the following best describes the calcaneus's role in weight-bearing mechanics?

It counteracts the compressive forces of the plantar fascia, tendons, and ligaments, while acting as a lever for the triceps surae. (D) Signup and view all the answers

Which statement accurately represents the structural relationship between the sustentaculum tali and its function?

It projects medially, providing a cortical support for the talar neck and acting as a fulcrum for the FHL tendon. (B) Signup and view all the answers

What is the primary implication of the posterior facet's downward slope from lateral to medial?

It complicates surgical visualization, requiring precise screw placement to obtain fixation without intra-articular penetration. (A) Signup and view all the answers

Which of the following best captures the stated view on long-term outcomes of calcaneal fractures?

Outcomes remain generally poor, and are often life-altering with chronic pain, gait issues and inability to return to work. (D) Signup and view all the answers

What is suggested in the information provided about the challenges associated with treating calcaneal fractures ?

Their treatment is often viewed as challenging with a difficult return to function due to its morphology. (B) Signup and view all the answers

Based on the information, what patient demographic is most likely to experience calcaneal fractures?

Adult males between 21-45, often involved in manual labor. (D) Signup and view all the answers

Which characteristic of the calcaneus is described as counteracting compressive forces during weightbearing?

Its dense cortical bone structure. (A) Signup and view all the answers

The middle and anterior facets of the calcaneus are described as:

Bearing more weight per unit area than the posterior facet. (B) Signup and view all the answers

Which of the following is a characteristic of the calcaneal tuberosity's displacement in an intra-articular fracture?

Displaces superiorly, rotates into varus, and shortens into the fracture (A) Signup and view all the answers

According to the provided data, what is the approximate difference in the percentage of patients with good or excellent long-term outcomes using the Iowa Calcaneal Scale (ICS), when comparing 10-year and 20-year follow-up results of non-operatively treated calcaneal fractures?

A decrease of 16% (C) Signup and view all the answers

In non-operative treatment, following initial splinting, when is it typically recommended to transition to a cast or fracture boot, and begin gentle range of motion exercises?

Within 7 to 14 days after the injury (D) Signup and view all the answers

Which of the following is NOT a generally accepted indication for operative treatment of calcaneal fractures, based on the presented information?

Fractures with less than 20% involvement of the calcaneocuboid joint (A) Signup and view all the answers

According to the information provided, what is the primary rationale for delaying calcaneal fracture surgery by 2 to 3 weeks post-injury?

To ensure adequate reduction of swelling and rest of traumatized soft tissues (B) Signup and view all the answers

When correcting calcaneal morphology using the sinus tarsi approach, what does addressing 'width' specifically aim to achieve?

Reduction of medial displacement to restore the calcaneal width. (B) Signup and view all the answers

In the context of calcaneal fracture reduction utilizing the sinus tarsi approach, which of the following best describes the treatment focus when addressing 'shortening'?

Restoring the length and height of the calcaneus to its pre-injury dimensions. (D) Signup and view all the answers

Besides the subtalar joint, what other joint is specifically targeted when addressing 'articular incongruity'?

The calcaneocuboid joint. (A) Signup and view all the answers

During a 'Joint Depression-Sinus tarsi Approach', how long is the typical duration spent in a non-weight bearing splint?

2-3 weeks. (D) Signup and view all the answers

Following the initial non-weight bearing splint phase of rehabilitation after a 'Joint Depression-Sinus tarsi Approach', what is the subsequent protocol?

Non-weight bearing in a boot for approximately 8 weeks with range of motion exercises. (A) Signup and view all the answers

What specific type of percutaneous fixation is used, as explicitly mentioned, for calcaneal fractures?

Tongue-type (Sanders 2C). (B) Signup and view all the answers

When considering which joints to address in 'articular incongruity' in calcaneal fractures, what is the correct order of priority as implied by the information?

Subtalar joint, then calcaneocuboid joint. (B) Signup and view all the answers

What specific correction mentioned is related to moving a fragment medially?

Correcting width to address the widened calcaneus. (B) Signup and view all the answers

A lateral radiograph of the calcaneus reveals a Böhler's angle of 15 degrees. Which of the following is the most likely interpretation?

A fracture with displacement of the posterior facet (B) Signup and view all the answers

An increase in the critical angle of Gissane seen in lateral radiographs of the calcaneus is most consistent with which condition?

A fracture affecting two strong cortical columns beneath the talus. (D) Signup and view all the answers

Which imaging view is most beneficial for visualizing the calcaneocuboid joint and the distal location of a primary calcaneal fracture line?

Anteroposterior or oblique view (B) Signup and view all the answers

Which of the following is best assessed when using the Harris Beath axial view?

The amount of varus or valgus angulation of the tuberosity and heel width (B) Signup and view all the answers

During use of Broden's views for calcaneal visualization, a sequential X-ray process is typically followed by angling the X-ray tube in which sequence of degrees?

40, 30, 20 and 10 degrees cephalad (B) Signup and view all the answers

According to the Sanders classification, a fracture involving four or more fragments of calcaneal posterior facet is categorized as:

Type IV (B) Signup and view all the answers

In the Sanders classification system, a Type 2B fracture is best described as:

A fracture line through the middle of the facet (B) Signup and view all the answers

A Sanders Type 3AC fracture would indicate:

Three fracture lines: one involving the lateral aspect and one adjacent to the sustenaculum tali. (A) Signup and view all the answers

Considering the long-term outcomes of non-operative management for calcaneal fractures, what is the approximate percentage decrease in patients achieving good or excellent results, as measured by the Iowa Calcaneal Scale (ICS), between the 10-year and 20-year follow-up periods?

Approximately 16% (D) Signup and view all the answers

In the context of operative treatment for calcaneal fractures, which of the following combinations of indications would MOST strongly suggest the need for surgical intervention over non-operative measures?

Displaced intra-articular fracture involving the posterior facet and a fracture dislocation of the calcaneus. (C) Signup and view all the answers

When considering the timing of surgical intervention for calcaneal fractures, the recommendation for delaying surgery by up to 2-3 weeks is primarily aimed at optimizing which of the following?

Ensuring adequate reduction of swelling and allowing for soft tissue rest. (C) Signup and view all the answers

A patient presents with severe heel pain, soft tissue swelling, ecchymosis, and a distorted heel contour following a high-velocity injury. In addition to these common symptoms, which of the following is also frequently observed with this type of injury?

Plantar ecchymosis (A) Signup and view all the answers

Following an intra-articular calcaneal fracture, which of the following best describes the common pattern of displacement of the calcaneal tuberosity?

Superior displacement with varus rotation and shortening into the fracture. (C) Signup and view all the answers

When assessing a patient with a suspected calcaneal fracture, which of the following is essential to determine, regarding neurovascular compromise?

The degree of impairment and overall condition of the neurovascular structures. (C) Signup and view all the answers

Following a calcaneal fracture, a patient displays a fracture pattern where the primary fracture line travels anterolaterally to posteromedially, with a lateral wall blowout. According to the provided details of the injury mechanism, what is the next most likely observation regarding secondary fracture lines?

The direction of the secondary fracture line will vary and is dependent on the specific vectorial force acting on the bone, and can lead to a 'Tongue-type' or 'Joint depression' fracture. (C) Signup and view all the answers

A patient presents with a calcaneal fracture and is managed non-operatively initially. After the initial phase of splinting, what would be the next step in the immobilization process, typically occurring within 7 to 14 days?

Conversion of the splint to either a cast or fracture boot. (A) Signup and view all the answers

A patient presents with a calcaneal fracture sustained from a fall from a considerable height. Besides standard AP and lateral views, which additional radiographic views would be most beneficial in fully assessing the fracture pattern?

AP, Lateral and Oblique of the Foot and Mortise view of the ankle. (D) Signup and view all the answers

During the assessment of a calcaneal fracture, a surgeon notes an 'Essex-Lopresti' type injury with two principal fracture lines. What is the key anatomical structure that is initially impacted by the primary fracture line in this scenario?

The lateral process of the talus being driven into the critical angle. (C) Signup and view all the answers

Which of the following best describes the role of the calcaneus in relation to the triceps surae?

It acts as a lever arm for the triceps surae muscle. (D) Signup and view all the answers

Which anatomical landmark of the calcaneus serves as the key support for the talar neck?

Sustentaculum tali (B) Signup and view all the answers

Which statement most accurately describes the load-bearing distribution among the calcaneal-talar articulations?

The posterior facet bears the majority of the weight. (A) Signup and view all the answers

Given the orientation of the posterior facet of the calcaneus, which surgical consideration is MOST critical?

Meticulous screw placement due to the downward slope from lateral to medial. (A) Signup and view all the answers

Based on the provided data, which age group is most commonly affected by calcaneal fractures?

21 to 45 years old (D) Signup and view all the answers

What is the MOST significant socioeconomic impact of calcaneal fractures, as mentioned in the text?

Substantial implications on the workforce and economy. (B) Signup and view all the answers

What function does the sustentaculum tali serve in relation to the flexor hallucis longus (FHL) tendon?

It serves as a fulcrum for the FHL tendon. (C) Signup and view all the answers

What is the proportion of displaced intra-articular calcaneal fractures out of all calcaneal fractures?

75% (C) Signup and view all the answers

In the context of calcaneal fracture reduction, what is the primary goal when addressing the 'varus' component of the deformity?

To achieve a valgus alignment of the calcaneus. (C) Signup and view all the answers

What is the most significant complication of calcaneal fractures that is directly related to surgical approach and postoperative management?

Stiffness due to scarring and soft tissue complications. (D) Signup and view all the answers

When addressing the 'shortening' deformity in a calcaneal fracture, what specific anatomical changes are targeted for correction?

Restoration of the calcaneal height and length by lengthening. (A) Signup and view all the answers

Which of the following is NOT an intended benefit of using a minimally invasive approach, such as the sinus tarsi approach, compared to traditional extensile approaches for calcaneal fractures?

Increased ability to address all articular surfaces directly. (D) Signup and view all the answers

Besides the subtalar joint, which other joint's articular incongruity is specifically addressed during the reduction of calcaneal fractures?

Calcaneocuboid joint (A) Signup and view all the answers

What is the established time frame for initial non-weight bearing (NWB) in a splint post-operatively for a calcaneal fracture followed by the traditional approach?

2-3 weeks (D) Signup and view all the answers

What is the primary goal when correcting the 'morphology' of a calcaneal fracture?

To correct width discrepancies and varus deformities. (D) Signup and view all the answers

According to the information provided, what is the rationale for increasing the sinus tarsi incision length compared to the initial 1cm incision?

To accommodate different reduction devices and enable better fracture visualization. (B) Signup and view all the answers

In the context of calcaneal fracture management with ring fixation, what is the intended effect of 'Distraction of the Calcaneus, STJ and Ankle joint'?

To protect articular surfaces by reducing weight-bearing stresses. (A) Signup and view all the answers

According to the surgical goals outlined for calcaneal fracture management, which of the following is considered the most crucial for optimal patient outcomes?

Restoration of function achieved with respect to soft tissues (B) Signup and view all the answers

During the surgical technique for calcaneal fracture reduction, what is the correct chronological order of the main steps?

Skeletal Traction, Fracture Reduction, Frame Application (C) Signup and view all the answers

From the provided advantages listed, which of the following most accurately describes the benefit of the discussed operative approach?

Rapid patient mobilization due to its weight-bearing status. (B) Signup and view all the answers

A patient presents with a beak fracture of the calcaneal tuberosity. Based on the Rowe classification, which category does this fracture fall into?

Rowe II a (C) Signup and view all the answers

A patient has an avulsion fracture of the calcaneal tuberosity involving the Achilles tendon insertion. According to the Rowe classification, how should this injury be categorized?

Rowe II b (B) Signup and view all the answers

A patient has a calcaneal body fracture that does not involve the subtalar joint as identified by Rowe's classification. Which category does this fracture fall into?

Rowe III (C) Signup and view all the answers

A calcaneal fracture that occurs due to a fall from a height with the foot plantarflexed would be classified by Rowe as which category?

Rowe IV (C) Signup and view all the answers

When addressing 'shortening' in a calcaneal fracture, what specific parameters are targeted for correction?

Height and Length (C) Signup and view all the answers

A surgeon aims to correct articular incongruity during calcaneal fracture management. Which joint combination is most specifically mentioned as requiring attention?

Subtalar and Calcaneocuboid (C) Signup and view all the answers

In the context of the 'Joint Depression-Sinus tarsi Approach' for calcaneal fracture correction, what is the initial recommended post-operative weight-bearing protocol?

Non-weight-bearing in a splint for 2-3 weeks (B) Signup and view all the answers

After an initial non-weight bearing phase with a splint, what is the next recommended phase for post-operative calcaneal rehabilitation?

Non-weight bearing boot for about 8 weeks, with ROM exercises (D) Signup and view all the answers

Considering all the factors to correct in calcaneal fractures, which of the following is the most comprehensive aim of surgical treatment?

Addressing morphology, shortening, and articular incongruity (D) Signup and view all the answers

If a patient requires correction of a varus deformity in the calcaneus fracture, what additional aspect of morphology should also be evaluated at the same time?

Width of the calcaneus (A) Signup and view all the answers

Following a calcaneal fracture treated with the described 'Joint Depression-Sinus tarsi Approach', what is the last stated phase of the rehabilitation before returning to work?

Transition to weight-bearing boot for 4 weeks (C) Signup and view all the answers

What is a common symptom associated with calcaneal fractures?

Severe pain and soft tissue swelling (B) Signup and view all the answers

Compartment syndrome is rarely associated with calcaneal fractures.

False (B) Signup and view all the answers

What mechanism of injury commonly leads to calcaneal fractures?

High-velocity motor vehicle accidents or falls from height. Signup and view all the answers

Plantar __________ is commonly observed with calcaneal injuries.

ecchymosis Signup and view all the answers

Match the types of fractures to their corresponding characteristics:

Tongue-type = Secondary fracture line Joint depression = Axial leads to displacement Lateral wall blowout = Primary fracture line Essex-Lopresti = Lateral process driven into critical angle Signup and view all the answers

What is one of the primary goals of surgery for calcaneal fractures?

Anatomic reduction of the Calcaneus (A) Signup and view all the answers

Calcaneal fractures are always intra-articular injuries.

False (B) Signup and view all the answers

What is the Rowe classification type for a fracture of the calcaneal tubercle?

I a Signup and view all the answers

The calcaneal fracture classification that involves the body without subtalar joint involvement is Rowe type ___ .

III Signup and view all the answers

Match the Rowe classification to their descriptions:

I a = Fracture of the medial or lateral tubercle II b = Avulsion fracture of the tuberosity involving the Achilles tendon IV = Intra-articular fracture of the body III = Oblique body fracture without STJ involvement Signup and view all the answers

Which of the following advantages is associated with the surgical technique mentioned for calcaneal fractures?

Soft tissue sparing (D) Signup and view all the answers

Distraction of the subtalar joint is aimed at protecting articular surfaces during calcaneal fracture surgery.

True (A) Signup and view all the answers

What type of fracture results from a strong pull of the Achilles tendon according to Rowe classification?

II b Signup and view all the answers

What percentage of tarsal fractures does calcaneal fractures represent?

60% (D) Signup and view all the answers

Calcaneal fractures are more common in females than in males.

False (B) Signup and view all the answers

What is the primary load-bearing articulation of the calcaneus?

Posterior facet Signup and view all the answers

Calcaneal fractures have a high risk for __________ changes and chronic pain.

disability Signup and view all the answers

Match the following calcaneal fracture features with their descriptions:

Intra-articular = Fractures that extend into the joint surface Displaced = Fractures where bone fragments are not aligned Non-displaced = Fractures where bone fragments remain in alignment Suprasyndesmosis = Fractures that occur above the level of syndesmosis Signup and view all the answers

Which statement best describes the consequence of calcaneal fractures?

They can lead to chronic issues including gait problems. (B) Signup and view all the answers

The sustentaculum tali provides support to the talar neck.

True (A) Signup and view all the answers

Identify one significant implication of calcaneal fractures on the workforce.

Inability to return to work Signup and view all the answers

Which of the following aspects of morphology needs to be corrected during the Joint Depression-Sinus Tarsi Approach?

All of the above (D) Signup and view all the answers

Articular incongruity primarily involves the subtalar joint and the calcaneocuboid joint.

True (A) Signup and view all the answers

What is the recommended non-weight bearing (NWB) duration in a splint following the Joint Depression-Sinus Tarsi Approach?

2-3 weeks Signup and view all the answers

During the rehabilitation phase for calcaneal fractures, the use of ___________ socks may be recommended.

compression Signup and view all the answers

Match the following deformities to their corresponding descriptions:

Width = Lateral deviation of the foot Varus = Medial angulation of the body part Shortening = Decrease in the length of the bone Articular incongruity = Misalignment of joint surfaces Signup and view all the answers

Which approach is indicated for addressing deformities due to calcaneal fractures?

Joint Depression-Sinus Tarsi Approach (B) Signup and view all the answers

Percutaneous fixation is used exclusively for joint reconstruction and not for fracture stabilization.

False (B) Signup and view all the answers

What is the main goal of addressing the shortening deformity in calcaneal fractures?

Restoring normal length of the calcaneus Signup and view all the answers

What mechanism is primarily responsible for isolated sustentaculum fractures?

Axial load and forced inversion (D) Signup and view all the answers

Calcaneal body fractures are classified as true intra-articular fractures.

False (B) Signup and view all the answers

What type of treatment is recommended for minimally displaced anterior process fractures?

Fracture boot and range-of-motion exercises Signup and view all the answers

A tuberosity avulsion fracture occurs due to a violent pull of the ________ complex.

gastrocnemius–soleus Signup and view all the answers

Match the types of anterior process fractures with their descriptions:

Type I = Non-displaced, extra-articular Type II = Displaced, extra-articular Type III = Displaced, intra-articular Signup and view all the answers

What condition may result from subtalar arthrosis after a calcaneal fracture?

Decreased range of motion (D) Signup and view all the answers

Operative treatment is indicated for sustentaculum fractures with less than 2 mm of displacement.

False (B) Signup and view all the answers

What surgical procedure might be performed for a painful nonunion of an anterior process fracture?

Excision of Fragment or ORIF Signup and view all the answers

Calcaneal fractures may lead to complications such as ________ and loss of fixation.

wound dehiscence Signup and view all the answers

What is a classic characteristic of tuberosity avulsion fractures?

Marked displacement endangering surrounding skin (A) Signup and view all the answers

What is the typical range for Böhler’s angle in degrees?

20 to 40 (B) Signup and view all the answers

The critical angle of Gissane is formed by two weak cortical columns.

False (B) Signup and view all the answers

What classification system is used to describe joint depression fractures in the calcaneus?

Sanders classification Signup and view all the answers

Essex-Lopresti classification primarily assesses the __________ feature.

anatomical Signup and view all the answers

Match the following angles or classifications to their descriptions:

Böhler's Angle = Indicates displacement of the posterior facet Critical Angle of Gissane = Formed by two strong cortical columns Sanders Type I = Indicates no displacement Sanders Type IV = Identifies highly comminuted fractures Signup and view all the answers

What does an increase in the critical angle of Gissane indicate?

Presence of fracture (C) Signup and view all the answers

Broden's views are still the preferred method for pre-operative assessment of the posterior facet.

False (B) Signup and view all the answers

What is the purpose of the Harris Beath axial view in assessing calcaneal fractures?

To evaluate the disruption of the articular surface and lateral wall Signup and view all the answers

What is the primary goal when addressing the 'varus' deformity of a calcaneal fracture?

To get back the valgus position (B) Signup and view all the answers

The lateral wall blowout is a common feature noted in morphology during calcaneal fractures.

False (B) Signup and view all the answers

What is typically included in the skin flap during a traditional lateral extensile approach for calcaneal fractures?

Sural Nerve, Peroneal Tendons, Calcaneofibular ligament Signup and view all the answers

When correcting morphology in calcaneal fractures, it is important to address shortening, height, and ________.

length Signup and view all the answers

Match the following components to their corresponding deformity corrections in calcaneal fractures:

Shortening = Get back the height and length Varus = Get back the valgus Wide = Move it medial Signup and view all the answers

Which of these deformities is primarily focused on restoring articular congruity during calcaneal fracture correction?

Articular Incongruity (D) Signup and view all the answers

Minimal skin retraction is a characteristic feature of the traditional lateral extensile approach.

True (A) Signup and view all the answers

What joint stabilization is primarily focused on in the indirect reduction of the sustentaculum tali during calcaneal fracture fixation?

Subtalar Joint Signup and view all the answers

The ______ angle is measured by a line connecting the highest point of the anterior process to the highest point of the posterior facet and a line drawn tangential to the superior edge of the tuberosity.

Böhler's Signup and view all the answers

Which of the following is a primary aspect of morphology to be corrected in calcaneal fractures?

Length (B) Signup and view all the answers

A decrease in Böhler's angle indicates a possible displacement of the weight-bearing posterior facet.

True (A) Signup and view all the answers

Which of the following is NOT a special imaging view used for assessing calcaneal fractures?

Lateral (B) Signup and view all the answers

Match the following imaging views to their primary purpose in assessing calcaneal fractures.

Lateral = Assessing the calcaneocuboid joint and primary fracture line Harris Beath Axial = Assessing the articular surface, displacement, and angulation Broden's Views = Visualizing the entire posterior facet from posterior to anterior (historically replaced by CT) CT Scans = Providing detailed 3D information, especially useful for the Sanders classification Signup and view all the answers

The sinus tarsi approach is indicated for Sanders type ___ fractures.

2 Signup and view all the answers

Match the terms related to calcaneal fractures with their correct definitions:

Weightbearing boot = 4 weeks duration NWB splint = 2-3 Weeks Minimally invasive approach = Reduces soft tissue damage Articular incongruity = Involves subtalar joint Signup and view all the answers

What should be achieved by correcting the 'shortening' deformity in a calcaneal fracture?

Restoration of height and length (A) Signup and view all the answers

Post-operative therapy for calcaneal fractures is generally discouraged.

False (B) Signup and view all the answers

Which complication is most significant for calcaneal fractures?

Soft tissue healing Signup and view all the answers

What is the primary goal of calcaneal fracture surgery?

Restoration of function and anatomy (B) Signup and view all the answers

Distraction of the joints protects the subtalar joint from weight-bearing stresses.

True (A) Signup and view all the answers

What condition is associated with a fracture of the sustentaculum tali?

Rowe I b Signup and view all the answers

The Rowe classification type that includes oblique body fractures not involving the subtalar joint is classified as __________.

III Signup and view all the answers

Match the Rowe classification with its description:

I a = Fracture of the calcaneal tubercle II b = Avulsion fracture of the tuberosity IV = Intra-articular body fracture III = Body fracture without STJ involvement Signup and view all the answers

Which of the following is NOT a consideration during percutaneous reduction with ring fixation?

Bone fragmentation (A), Soft tissue concerns (B), Size and weight bearing (D) Signup and view all the answers

Most common extra-articular fracture type according to Rowe classification is type III.

True (A) Signup and view all the answers

In the Rowe classification, a fracture involving the anterior process is categorized as type __________.

I c Signup and view all the answers

Which of the following statements about calcaneal fractures is true?

Most calcaneal fractures are displaced intra-articular fractures. (D) Signup and view all the answers

Calcaneal fractures primarily affect the older population.

False (B) Signup and view all the answers

The calcaneus serves as a lever arm for the __________.

triceps surae Signup and view all the answers

Match the following calcaneal fracture descriptions with their characteristics:

Intra-articular = 75% of all calcaneal fractures Extra-articular = Fractures that do not extend into the joint Displaced = Fragments are not aligned Non-displaced = Fragments remain in alignment Signup and view all the answers

What high risk is associated with calcaneal fractures?

Chronic pain (A) Signup and view all the answers

The sustentaculum tali serves as a site for ligament insertion.

True (A) Signup and view all the answers

What percentage of tarsal fractures does the calcaneus account for?

60% Signup and view all the answers

What should be corrected when addressing 'shortening' in a calcaneal fracture?

Height and Length (A) Signup and view all the answers

The Joint Depression-Sinus tarsi approach addresses only the taller structure of the calcaneus.

False (B) Signup and view all the answers

Name the two joints involved in articular incongruity related to calcaneal fractures.

Subtalar Joint, Calcaneocuboid Joint Signup and view all the answers

After surgery using the Joint Depression-Sinus tarsi approach, patients typically undergo a non-weight bearing (NWB) period of _____ weeks.

2-3 Signup and view all the answers

Match the following deformities with the aspects they correct in calcaneal fractures:

Width = Varus Shortening = Height Articular Incongruity = Subtalar Joint Signup and view all the answers

What is one of the typical post-operative protocols mentioned for calcaneal fracture management?

Compression Socks (A) Signup and view all the answers

Percutaneous fixation primarily addresses morphological deformities in calcaneal fractures.

True (A) Signup and view all the answers

What type of fixation is described as the 'Tongue Type' in relation to calcaneal fractures?

Sanders 2C Signup and view all the answers

What distinguishes open fractures from blasting injuries compared to those in civil life?

They often have more severe soft-tissue damage, possibly leading to amputation. (A) Signup and view all the answers

In the context of open fracture management, what is considered a mandatory step, particularly differentiating it from military-related injuries?

Early bone coverage by a free flap. (B) Signup and view all the answers

What is a typical method of reduction for an extra-articular tongue-type calcaneal fracture?

Plantar flexion of the foot and fixation with cancellous bone screws. (A) Signup and view all the answers

What is the primary benefit of using washers in the fixation of an extra-articular tongue-type fracture?

To apply compression with lag screws (B) Signup and view all the answers

In the treatment of calcaneal fractures, what is the main concern that LISs (Less Invasive Surgeries) try to avoid?

Wound complications usually caused by open surgery. (B) Signup and view all the answers

What is a key disadvantage of LIS when compared to ORIF in managing calcaneal fractures?

Less accurate articular reduction. (C) Signup and view all the answers

When treating a tongue-type fracture with percutaneous screws, what anatomical position is stated as safe, with excellent visualization?

LIS position. (A) Signup and view all the answers

What is a typical fracture configuration of the calcaneal tuberosity in an extra-articular tongue-type fracture?

It is longitudinally split in two parts. (D) Signup and view all the answers

In a calcaneal fracture where the sustentaculum tali is separated, to which bone does the sustentaculum tali remain attached?

Tibia (C) Signup and view all the answers

Which structure is most likely to be directly compressed or incarcerated within a calcaneal fracture located immediately below the sustentaculum tali?

Flexor hallucis longus tendon (A) Signup and view all the answers

Damage to which neurovascular bundle is most closely associated with a fracture of the sustentaculum tali?

Tibial nerve and posterior tibial artery (C) Signup and view all the answers

What is a specific risk concerning the flexor hallucis longus tendon in cases of a calcaneal fracture directly beneath the sustentaculum tali?

Tendon incarceration within the fracture site (C) Signup and view all the answers

Which specific radiological projection is primarily used to assess the calcaneal tuberosity, anterior process, and medial and lateral cortex?

Lateral view (D) Signup and view all the answers

Which specific radiological view is typically optimal for visualizing the sustentaculum tali and the impact of its relation to a calcaneus fracture?

Axial view (C) Signup and view all the answers

If damage occurs to the tibialis posterior neurovascular bundle due to a sustentaculum tali fracture, what primary clinical sign would be most directly expected?

Loss of sensation on the plantar aspect of the foot (C) Signup and view all the answers

Which of the following best describes the relevance of the deltoid ligament when it comes to sustentaculum tali fractures?

It maintains the connection between the sustentaculum tali and tibia when fractured (D) Signup and view all the answers

What is a potential long-term complication associated with subtalar arthrodesis, despite its efficacy in pain management?

Degenerative changes in the ankle joint. (B) Signup and view all the answers

In which scenario is primary subtalar arthrodesis MOST likely considered as a leading treatment option?

For markedly comminuted intra-articular Sanders type IV calcaneal fractures. (A) Signup and view all the answers

What is the key benefit attributed to initial open reduction and internal fixation (ORIF) before subtalar fusion, according to some authors?

It ensures complete restoration of the calcaneal shape, height and alignment, facilitating fusion. (D) Signup and view all the answers

Which of the following is the most significant obstacle in conducting stratified analysis of calcaneal fracture treatment outcomes, due to the lack of sufficient published cases?

The inability to account for key patient variables. (A) Signup and view all the answers

What is a notable advantage of an arthroscopic approach to subtalar arthrodesis, particularly in managing soft-tissue concerns?

It allows easier and safer performance, especially in the presence of soft-tissue issues. (C) Signup and view all the answers

Despite the inability to perform detailed stratified analysis, what crucial area of understanding has been significantly improved through the study of calcaneal fractures?

An in depth understanding of fracture patterns, physiopathology, and general principles of treatment. (A) Signup and view all the answers

What limitation is identified when analyzing and comparing non-operative (NO) and operative treatment (OT) of calcaneal fractures?

The wide variability in patient characteristics, fracture patterns and surgical techniques. (C) Signup and view all the answers

What limitation is primarily responsible for preventing more robust statistical analysis in the context of calcaneal fracture management?

The lack of well-designed studies with a sufficient number of cases. (B) Signup and view all the answers

What is a specific methodological challenge encountered when drawing definitive conclusions from studies related to surgical approaches for calcaneal fractures?

The variability in surgical techniques and treatment protocols used. (B) Signup and view all the answers

When does the text suggest that the addition of a subtalar release or fusion could be considered?

Concurrently, at the same time as a surgical approach. (A) Signup and view all the answers

Which aspect of calcaneal fracture research is specifically noted to be limited due to the scarcity of robust data?

The precise quantification of patient specific factors. (C) Signup and view all the answers

What is the key focus of the database search performed by the authors for the creation of a systematic review on calcaneal fractures?

For systematic reviews, clinical trials and evidence based medicine. (A) Signup and view all the answers

While numerous patient variables are acknowledged to potentially impact outcomes of calcaneal fracture treatment, why is it difficult to demonstrate their direct effects?

The limited number of published cases makes stratification impossible. (D) Signup and view all the answers

In the context of calcaneal fracture research, what effect does the absence of large data sets have on the analysis of patient-specific factors?

It restricts the ability to conduct robust stratification. (B) Signup and view all the answers

The text implies that due to limitations of available data, what aspect of calcaneal fractures remains particularly challenging to investigate?

The clinical outcomes across patient subgroups based on specific characteristics. (D) Signup and view all the answers

Which of the following BEST captures the data analysis challenge highlighted in the text regarding calcaneal fracture research?

The inability to account for confounding variables due to limited data. (C) Signup and view all the answers

Which of the following treatment methods for calcaneal fractures primarily utilizes the injection of bone cement to aid in reduction?

Percutaneous reduction and injection of Norian bone cement (D) Signup and view all the answers

Which of the following studies specifically addressed the impact of soft tissue injuries on the outcome of open calcaneal fractures?

Heier KA, Infante AF, Walling AK, Sanders RW. (B) Signup and view all the answers

Which study specifically detailed a staged treatment plan for Type II and Type IIIA open calcaneus fractures?

Mehta S, Mirza AJ, Dunbar RP, Barei DP, Benirschke SK. (C) Signup and view all the answers

In which publication does research on the long-term outcomes of conservative treatment for Sanders type 4 calcaneal fractures appear?

Journal of Bone & Joint Surgery (British Volume) (D) Signup and view all the answers

Which study focused on percutaneous reduction and fixation of displaced intra-articular calcaneus fractures?

DeWall M, Henderson CE, McKinley TO, Phelps T, Dolan L, Marsh JL. (B) Signup and view all the answers

What publication presents a study evaluating the significance of the medial fracture line in calcaneus fractures?

Journal of Foot and Ankle Surgery (D) Signup and view all the answers

Which of the following techniques is associated with the use of K-wires for stabilization in the context of calcaneal fractures, specifically following treatment?

Triple arthrodesis (D) Signup and view all the answers

Which study explored calcaneal blast fractures resulting from vehicle explosions, specifically using the term 'deck-slap' injury?

Ramasamy A, Hill AM, Phillip R, Gibb I, Bull AM, Clasper JC. (A) Signup and view all the answers

What is the primary focus of arthroscopic subtalar arthrodesis, as mentioned in the provided references?

Achieving fusion of the subtalar joint to alleviate pain and instability. (A) Signup and view all the answers

According to the provided studies, which surgical approach is MOST commonly associated with the arthroscopic treatment of subtalar issues following calcaneal fractures?

Posterior 2-portal approach in the prone position. (A) Signup and view all the answers

What is one specific outcome from calcaneal fractures that may lead to a need for subtalar arthroscopy, according to the document?

Persistent subfibular pain. (D) Signup and view all the answers

What aspect of post-calcaneal fracture management is addressed by arthroscopic release?

Painful subtalar stiffness. (A) Signup and view all the answers

According to the provided studies, which of the following is the MOST significant outcome difference between operative and non-operative treatment of intra-articular calcaneal fractures?

Final range of subtalar motion. (D) Signup and view all the answers

What specific methodology was primarily used in the studies that compared outcomes of operative versus nonoperative management of calcaneal fractures?

Prospective randomized trials. (D) Signup and view all the answers

What is a primary reason for performing a surgical intervention in calcaneal fractures, as inferred by the provided documents?

To improve articular congruity and alignment. (C) Signup and view all the answers

What was the primary objective of the study mentioned in the provided text, regarding calcaneal fractures, described as a "nationwide survey"?

To examine current treatment methods. (B) Signup and view all the answers

Based on the provided information, which of the following is a primary reason for considering a medial approach to calcaneal fracture fixation?

A medial approach allows for direct fixation of the sustentaculum tali and medial fragments. (D) Signup and view all the answers

How does varus deformity contribute to the instability of the foot during gait, as described in the content?

Varus deformity leads to lateral subluxation of the talus, overloading the tibialis posterior tendon. (A) Signup and view all the answers

Which of the following statements accurately reflects a potential drawback of extending the lateral approach for calcaneal fracture fixation?

Extended lateral approaches may increase the chance of skin vascularisation issues, potentially impacting healing. (A) Signup and view all the answers

Which of the following best describes the primary rationale for addressing the 'shortening' deformity in a calcaneal fracture?

Correcting shortening primarily aims to restore the normal biomechanics of the foot, specifically during push-off. (A) Signup and view all the answers

In the context of calcaneal fracture reduction, what specific aspect is primarily addressed by moving the tuberosity fragment medially?

This maneuver corrects the varus deformity by restoring the proper alignment of the calcaneus. (B) Signup and view all the answers

Which of the following anatomical structures is considered a primary target for fixation when using a medial approach for calcaneal fracture?

The sustentaculum tali, which is crucial for supporting the talus and maintaining medial arch integrity. (C) Signup and view all the answers

Why is the tibialis posterior tendon specifically noted as being affected by varus deformity after a calcaneal fracture?

The tibialis posterior tendon is subjected to increased tension due to lateral displacement of the talus, increasing the risk of strain or rupture. (B) Signup and view all the answers

Which of the following best describes why correcting the shortening deformity in a calcaneal fracture is considered a primary objective?

Correcting shortening primarily focuses on restoring the proper biomechanics of the foot, particularly during the push-off phase of gait. (B) Signup and view all the answers

What is the reported incidence of infectious complications following the percutaneous distraction reduction and fixation technique?

2–15% (B) Signup and view all the answers

In the context of percutaneous distraction reduction, what percentage of patients may require a secondary arthrodesis?

2–15% (D) Signup and view all the answers

What is the range of loss of reduction reported in patients undergoing percutaneous distraction reduction?

4–67% (C) Signup and view all the answers

What is the primary advantage of operative management of displaced intra-articular calcaneal fractures compared to non-operative treatment?

Lower cost and more effectiveness (D) Signup and view all the answers

What is considered critically important for safe fixation of screws in calcaneus fracture osteosynthesis?

Knowledge of the internal anatomy of the calcaneus (B) Signup and view all the answers

What is the proposed role of bioabsorbable osteosynthesis materials in the management of fractures?

They show promising results but require more studies. (D) Signup and view all the answers

What kind of study analyzed nearly 1000 cases in relation to calcaneal fractures?

Dutch postal survey (C) Signup and view all the answers

What treatment modality has been suggested to have an acceptable complication rate for displaced intra-articular calcaneal fractures?

Percutaneous distraction reduction and fixation (D) Signup and view all the answers

In addressing calcaneus fractures, what is vital regarding soft tissue preservation?

To preserve as much soft tissue as possible to avoid complications. (A) Signup and view all the answers

In terms of return to work rates, what effect does operative treatment have over non-operative treatment?

Higher rates of return (D) Signup and view all the answers

What complication, although rare, can occur in cases of calcaneus fractures?

Compartment syndrome (C) Signup and view all the answers

Which classification system is employed to evaluate intra-articular calcaneal fractures?

Sanders classification (B) Signup and view all the answers

What method is part of the surgical approach to ensure adequate stability in a calcaneus fracture reconstruction?

Utilizing K-wires alongside bone grafts (A) Signup and view all the answers

Which fixation method is recommended for calcaneus fractures for optimal reconstruction?

Compression plate or locking plate (A) Signup and view all the answers

What is a significant factor that affects the outcomes of calcaneus fracture surgeries?

Surgeon's familiarity with the technique (C) Signup and view all the answers

What should be discarded during the management of calcaneus fractures to avoid complications?

Protruding surgical materials (A) Signup and view all the answers

What is the primary benefit of using arthroscopy in the treatment of calcaneus fractures?

It allows for better visualization and stability without soft tissue interference. (D) Signup and view all the answers

What is the gold standard for reconstructing the subtalar joint in calcaneus fractures?

A column of tricortical autograft. (D) Signup and view all the answers

Which condition might justify the use of arthroscopy after sustaining a calcaneus fracture?

Calcaneo-fibular impingement syndrome. (C) Signup and view all the answers

What is a significant drawback of harvesting autografts from the iliac crest?

Leads to considerable morbidity and recovery time. (C) Signup and view all the answers

What is the role of arthroscopy in achieving accurate joint restoration during calcaneus fracture treatments?

It allows for the precise assessment and reduction of articular surfaces. (A) Signup and view all the answers

Which method is not mentioned as a type of bone substitute to fill the cavity left by lifting fragments in calcaneus fracture reconstruction?

Synthetic polyethylene graft. (A) Signup and view all the answers

Which classification type is most relevant when discussing arthroscopic treatment for calcaneal fractures?

Sanders classification. (C) Signup and view all the answers

What is a primary function of a tricortical bone graft in calcaneal fracture surgery?

To stabilize the joint surface by buttressing the subchondral bone. (C) Signup and view all the answers

What was a significant consequence observed following intra-articular calcaneal fracture management?

Improvements in dynamic plantar pressure distribution (A) Signup and view all the answers

Which procedure is suggested for cases of post-traumatic subtalar arthritis?

Arthroscopic subtalar fusion (D) Signup and view all the answers

In evaluating the economic impact of calcaneal fracture management, what approach was compared?

Operative versus nonoperative management (C) Signup and view all the answers

What factor is critical to determine the treatment approach for intra-articular calcaneal fractures?

Degree of articular surface involvement (B) Signup and view all the answers

Which specific complication is highlighted as significant in the context of calcaneal fractures?

Vascular necrosis of the talus (C) Signup and view all the answers

Which imaging view is specified as essential for assessing the calcaneus?

Harris Beath axial view (B) Signup and view all the answers

In the context of surgical management for calcaneal fractures, what anatomical feature is often evaluated?

Sustentaculum tali and its integrity (A) Signup and view all the answers

What critical angle measurement is most relevant during calcaneal fracture assessment?

Böhler's angle (C) Signup and view all the answers

Which of the following classification systems is specifically mentioned as having limited inter-observer reliability and reproducibility?

Letournel (A), AO-OTA (D) Signup and view all the answers

According to the provided information, what is the primary goal of addressing the 'shortening' deformity in a calcaneal fracture?

Restoring the proper length of the calcaneus (D) Signup and view all the answers

Which of the following is a true statement regarding the Sanders classification of calcaneal fractures?

It exclusively focuses on the degree of comminution in the posterior facet. (B) Signup and view all the answers

According to the provided information, what is the primary concern regarding the use of percutaneous reduction with ring fixation for calcaneal fractures?

It does not address all the key deformities associated with these fractures. (C) Signup and view all the answers

What is the main feature that is assessed during the 'Joint Depression-Sinus tarsi Approach' to determine the morphology of the calcaneal fracture?

The extent of articular incongruity (D) Signup and view all the answers

Based on the information provided, what is the main advantage of using minimally invasive approaches to calcaneal fracture fixation?

They result in less soft tissue damage compared to open procedures. (D) Signup and view all the answers

Which Rowe classification, as described in the text, specifically refers to a calcaneal fracture that spares the Achilles tendon insertion?

Type 1 (C) Signup and view all the answers

What happens when a fracture affects the calcaneocuboid joint?

Worse prognosis (C) Signup and view all the answers

Loss of Böhler's angle can lead to a traumatic flat foot.

True (A) Signup and view all the answers

What is the significance of Gissane's angle in relation to calcaneal fractures?

It indicates the positioning of fracture lines. Signup and view all the answers

Which of the following classifications focuses on fracture patterns but has limited inter-observer reliability?

Letournel’s (A) Signup and view all the answers

The __________ is attached to the medial malleolus by the deltoid ligament.

medial joint Signup and view all the answers

Which injury type is indicated by a fracture of the sustentaculum tali?

Type III in Rowe classification (B) Signup and view all the answers

Intra-articular calcaneal fractures are typically caused by a sudden load applied to the heel.

True (A) Signup and view all the answers

Match the fracture patterns with their characteristics.

Extrarticular tongue-type = Resulting from Achilles tendon traction Fracture affecting calcaneocuboid joint = Worse prognosis Flattening of posterior subtalar joint = Decrease in Böhler's angle Medial joint not dislocated = Capsular attachment preserved Signup and view all the answers

What are the two major fragments identified in calcaneal fractures?

Anteromedial and posterolateral fragments. Signup and view all the answers

The fracture patterns in calcaneal fractures depend on the position of the foot and the __________ at the moment of the injury.

force Signup and view all the answers

A well-preserved anterior area of the lateral cortex leads to an increased chance of impingement.

False (B) Signup and view all the answers

Match the fracture classifications with their main features:

Essex-Lopresti = Tongue-type and joint depression Sanders = CT coronal slice-based prognostic classification Letournel = Limited inter-observer reliability AOFAS = Foot and Ankle Society classification Signup and view all the answers

What surgical information do 3-D views provide regarding calcaneal fractures?

They provide vital information for surgical planning. Signup and view all the answers

Which type of fractures affects the anterior process of the calcaneus?

Extra-articular fractures (D) Signup and view all the answers

The posterior facet's comminution indicates a better prognosis according to Sanders' classification.

False (B) Signup and view all the answers

The __________ angle is often referenced in relation to calcaneal fractures and their prognosis.

Gissane's Signup and view all the answers

What does the Sanders classification primarily categorize in relation to calcaneal fractures?

Joint depression fractures (C) Signup and view all the answers

Operative treatment includes methods such as external fixation and arthroscopic reduction.

True (A) Signup and view all the answers

What is the primary goal of treatment for calcaneal fractures?

Joint restoration Signup and view all the answers

The lateral process of the talus creates a 'primary fracture line' by hammering the floor of the sinus ______.

tarsi Signup and view all the answers

Match the following terms with their descriptions:

Böhler's angle = An indicator of calcaneal fracture severity Gissane's angle = A critical angle related to calcaneal morphology Anteromedial fragment = Part of the calcaneus in fractures Posterolateral fragment = Another major fragment in calcaneal fractures Signup and view all the answers

What type of injury is described as 'calcaneal blast fractures'?

Injuries from vehicle explosions (D) Signup and view all the answers

Soft tissue injury does not affect the outcome of open fractures of the calcaneus.

False (B) Signup and view all the answers

What is the primary purpose of a staged treatment plan in managing calcaneus fractures?

To provide a systematic approach in treating different types of open fractures. Signup and view all the answers

The __________ sign is significant in assessing the medial fracture line in calcaneal fractures.

medial fracture line Signup and view all the answers

Match the following treatment methods with their descriptions:

K-wire stabilization = Used for stabilizing fractures post-implementation Percutaneous reduction = Minimally invasive method to fix the fracture Subtalar fusion = Surgical procedure to join bones after displacement Closed reduction and percutaneous osteosynthesis = Technique used for fracture alignment Signup and view all the answers

Which classification method is utilized to categorize joint depression fractures of the calcaneus?

Sanders classification (C) Signup and view all the answers

The critical angle of Gissane is used to evaluate calcaneal fractures.

True (A) Signup and view all the answers

What is the focus of treatment for Sanders type 4 fractures of the calcaneum?

Long-term conservative treatment. Signup and view all the answers

What approach is commonly used for arthroscopic subtalar arthrodesis according to studies?

Posterior 2-portal approach (D) Signup and view all the answers

Operative treatment of intra-articular fractures of the calcaneus refers to treatment that does not involve surgery.

False (B) Signup and view all the answers

What is the main benefit of using minimally invasive approaches to calcaneal fracture fixation?

Less soft tissue damage and improved recovery time Signup and view all the answers

Arthroscopic release is often performed for painful subtalar stiffness after __________ of the calcaneum.

intra-articular fractures Signup and view all the answers

Match the following studies with their focus area:

Lee KB et al. 2010 = Subtalar arthrodesis Thordarson DB et al. 1996 = Operative vs nonoperative treatment Dhillon MS et al. 2011 = Controversies in management SooHoo NF et al. 2011 = Complication rates Signup and view all the answers

What was the primary focus of the study by Elgafy H, Ebraheim NA?

Persistent subfibular pain after calcaneal fractures (D) Signup and view all the answers

Calcaneal fractures represent a significant percentage of all fractures that occur.

True (A) Signup and view all the answers

In the context of calcaneal fractures, what is the most significant predictor of poor outcome?

Articular incongruity Signup and view all the answers

Which condition indicates a major soft-tissue danger?

Blood-filled blisters (A) Signup and view all the answers

The sinus tarsi serves as a pathway for approaching the medial and anterior facets of the calcaneus.

True (A) Signup and view all the answers

What anatomical feature must be partially removed to access the medial and anterior facets from a lateral approach?

Interosseous ligament Signup and view all the answers

The fracture that contains the anterior and medial facets is referred to as the ______ fragment.

anteromedial Signup and view all the answers

Match the following parts of the calcaneus with their descriptions:

Anterior process = The part that helps in articulating with the talus Tuberosity = The large posterior region that provides support Sinus tarsi = The pathway to access medial and anterior facets Calcaneocuboid joint = Joins the calcaneus to the cuboid bone Signup and view all the answers

Which of the following describes the function of Böhler’s angle when assessing calcaneus fractures?

Assesses the posterior facet morphology (B) Signup and view all the answers

Clear-fluid blisters indicate that a safe skin incision cannot be made.

False (B) Signup and view all the answers

What is altered when the patient's calcaneus fracture is evaluated through a CT scan?

Böhler and Gissane angles Signup and view all the answers

Study Notes

Calcaneal Fractures: Intra-articular

Calcaneal fractures account for 2% of all fractures.
They are the most common fracture of the tarsal bones, comprising 60% of tarsal fractures.
75% of calcaneal fractures are displaced intra-articularly.
Calcaneal fractures are serious and debilitating injuries.
Operative treatment is challenging, described as "nailing a custard pie to the wall".
Patients are typically male laborers aged 21-45.
These injuries significantly impact the workforce and economy.
They are considered a life-altering event, potentially leading to chronic pain, gait issues, and an inability to return to work.
The #1 predictor of poor outcome from calcaneal fracture is stiffness.
The majority of complications involve soft tissue healing.
Minimally invasive approaches are being explored to improve outcomes.
The majority of complications result from soft tissue healing.
The most significant predictor of a poor outcome from a calcaneal fracture is stiffness.
Significant variability in the fracture patterns of displaced intra-articular fractures exist, however, three consistent aspects are noted:
- The sustentaculum tali remains attached to the talus (constant fragment).
- Anterior calcaneal process translation.
- Calcaneal tuberosity displacement, which is superior, rotates into varus, and shortens.

Objectives

Identify calcaneus anatomy and soft tissue relationships.
Describe the mechanism of calcaneal fracture injuries.
Outline various calcaneal fracture patterns.
Detail conservative and surgical approaches for management.

Incidence

Calcaneal fractures account for 2% of all fractures, and are the most common tarsal bone fracture (60%).
Most (75%) are displaced intra-articular fractures.

How bad are calcaneal fractures???

The text includes historical quotes emphasizing the severity and poor outcomes from calcaneal fractures.
"The man who breaks his heel bone is done" (Cotton, 1916).
"Calcaneus fractures are serious and debilitating injuries in which the end result continues to be incredibly bad" (Conn, 1935).

Anatomy - Calcaneus

The calcaneus counteracts compressive forces during weight-bearing, acting as a lever arm for the triceps suræ.
It's a crucial component in the foot's supporting ligaments and tendons.
Its sustentaculum tali provides a shelf of bone to support the talar neck.
The FHL tendon has a groove on the medial surface
It articulates with the talus, cuboid, and other tarsal bones.
Various facets (anterior, middle, posterior) have specific articulations and bear different amounts of weight per unit area.
The posterior facet carries the most weight.
The key anatomical concept is the slope of the posterior facet, which descends from the lateral to the medial side. This can be difficult to visualize during surgery, impacting screw placement.

Anatomy - Vasculature

The calcaneus receives blood supply from branches of the posterior tibial artery and peroneal artery.
Branches innervate the surrounding tissues.

Anatomy - Soft Tissue

The calcaneus is surrounded by significant soft tissues for function.
These include tendons (Achilles, FHL, FDL, peroneals), nerves (tibial, peroneal, sural), and ligaments.
Soft tissues, such as the calcaneofibular ligament, support the surrounding ligaments and joints.

History

Patient should have their pain location and intensity documented.
Swelling, ecchymosis (bruising), and heel contour distortion are common.
Plantar ecchymosis often accompanies the injury.
The chance of associated injuries is high (up to 50%); this includes compartment syndrome, lower extremity injuries, and spinal injuries.

Detailed History Taking

Essential details need to be ascertained: pre-injury activities, occupation, social history, and past medical history (PMH).

Physical Exam

Examine the skin (injuries, blisters, necrosis).
Check for open wounds and signs of infection.
Evaluate neurovascular function (pulse, sensation, motor function, toes).
Assess toe movement.

Mechanism of Injury

Common causes of calcaneal fractures: high-velocity motor vehicle accidents (MVAs), falls from significant heights.

Intra-articular Fractures

Specific fracture mechanisms relate to the wedge-shaped geometry of the talus and the critical angle of the calcaneus.
Lateral talus process forces into the calcaneus like a wedge, causing fracture lines extending from the anterolateral to the posteromedial aspect.

Imaging

X-rays (AP, lateral, mortise of the ankle, oblique views of the foot), often contralateral for comparison.
Lateral imaging to assess Böhler's angle, neutral triangle, and Essex-Lopresti classification.
AP and oblique views to reveal specific fracture line location, especially in relation to the calcaneocuboid joint.
CT scans (Broden's views) are helpful for comprehensive pre-operative visualization of the posterior facet.

Sanders Classification

Classifies calcaneal fractures, particularly joint depression fractures, into different types (1–4) based on the number and disposition of fragments.

What do we definitely know...?

Displaced intra-articular fractures show significant variability in fracture patterns. Three consistent aspects are:
- The sustentaculum tali remains attached to the talus (constant fragment).
- Anterior calcaneal process translation.
- Calcaneal tuberosity displacement, superiorly, rotates into varus, and shortens.

Non-Operative Treatment

Initial management: elevation and splinting, followed by conversion to a cast or fracture boot within 7–14 days.
Gentle range of motion; non-weight bearing, often up to 12 weeks.
Reported long-term outcomes of 19 patients treated non-operatively:
- At 10 years, 63% good/excellent results, while 37% were fair/poor.
- At 20 years, only 47% had good/excellent results.

Operative Treatment

Indications: displaced intra-articular fractures involving the posterior facet, fracture dislocations, fractures with >25% calcaneocuboid involvement.
Methods: ORIF with lateral extensile incision, ORIF with sinus tarsi incision, percutaneous, or external fixation.

Timing of Surgery

Delay up to 2–3 weeks post-injury.
Adequate reduction of swelling and rest for the traumatized soft tissues.
A positive wrinkle test is a good indicator.

Joint Depression-Traditional Lateral Extensile

Correct all deformities (morphology, width, varus, shortening, height, length, articular incongruity, joint-specific correction).
Detailed step-by-step surgical procedures were described

Percutaneous Fixation

Often used for specific fractures, including tongue-type (Sanders 2C).
Correct all deformities (width, varus, shortening, height, length, articular incongruity, subtalar joint).
Timing of surgery: swelling reduction and test for positive wrinkle test.

External Fixation

Used for complex cases or additional injuries/complications.
Longer immobilization period is common.
Focus on fracture-specific corrections.

Percutaneous Reduction with Ring Fixation

Soft tissue concern/bone fragmentation not a primary issue but important in this type of surgery.
Distraction of the calcaneus, but also the subtalar and ankle joints, not a major factor.

Goals of the Surgery

Careful soft tissue respect.
Anatomic calcaneal reduction.
Immediate full weight-bearing.
Restoration of joint function.

Surgical Technique - Steps

(Details were described multiple times)

Intraoperative Assessment

(Details were described multiple times)

Advantages of the approach

Weight-bearing status: OR time less than 45 minutes; soft tissue sparing.
Reproducible results/classification system relevance less important.

Calcaneal Fractures: ‘Extra-Articular’

20% of all calcaneal fractures.
Similar injury mechanisms to intra-articular fractures (but lower energy).
Fracture lines do not extend to the posterior facet for this fracture subtype.
Rowe classification is more applicable for extra-articular fractures.

Rowe Classification

Details previously provided, including each sub-type, and their respective injury mechanisms.

Sustentaculum Fractures

Mechanism of injury: forced inversion and plantar flexion.
Extra-articular, but often associated with subtalar joint incongruity/dislocations.
Non-operative treatment: 10-12 weeks of fracture boot/ROM exercises.
Operative treatment: displacement more than 2mm, medial facet depression/extension to the posterior facet.

Anterior Process Fractures

Mechanism of injury: forced inversion and plantar flexion.
Degan Classification: Type I (non-displaced, extra-articular), Type II (displaced, extra-articular), Type III (displaced, intra-articular).
Non-operative treatment: nondisplaced fractures immobilized in a fracture boot, with ROM once acute swelling is reduced.
Operative treatment: excision of fragments, ORIF for larger or displaced fragments, or involvement in an unstable midfoot injury.

Tuberosity Avulsion Fracture

Mechanism: violent pull of the gastrocnemius-soleus complex/forced dorsiflexion.
Avulsed fragment size variable.
Involves Achilles tendon insertion directly.
Treatment considerations, depending on displacement.

Calcaneal Body Fracture

20% of calcaneal fractures (classified as extra-articular).
Similar injury mechanisms to intra-articular fractures (lower energy impact).
Fracture lines do not extent to the posterior facet.

Calcaneal Fracture Complications

Subtalar arthrosis, decreased ROM, wound dehiscence, osteomyelitis, loss of fixation, malalignment, subfibular impingement, other injuries as determined by case specifics.

Calcaneal Fracture Salvage Procedures

Subtalar arthrosis.
Common salvage options include in situ or distraction arthrodesis.
Wound complications: wound care to prevent dehiscence, osteomyelitis, and aggressive debridement where required.

Thank You!

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Test your knowledge on calcaneal fractures with this quiz! Explore topics related to intra-articular fractures, treatment outcomes, and patient demographics. Perfect for students and professionals in orthopedics and rehabilitation.

Calcaneal Fractures Quiz

Choose a study mode

Podcast

Questions and Answers

Which of the following is NOT a consistent feature directly associated with intra-articular calcaneal fractures as described?

According to the provided information on non-operative treatment outcomes, what percentage of patients demonstrated good or excellent results at the 20 year follow up using the Iowa Calcaneal Scale?

In the initial management of non-operative treatment for calcaneal fractures, what is typically used as a compressive dressing under a posterior splint?

Which of the following is NOT typically an indication for operative treatment of calcaneal fractures?

What is the recommended time frame to delay surgery post calcaneal fracture injury to allow for reduction of swelling and rest of soft tissues?

What percentage of all fractures do calcaneal fractures represent?

Which of the following best describes the typical patient demographic for calcaneal fractures?

Besides the subtalar joint, How many articulations does the calcaneus have with adjacent tarsal bones?

Which structure serves as the site of insertion for the tibiocalcaneal component of the deltoid ligament?

Which of the following best describes the orientation of the posterior facet of the calcaneus?

What is the primary functional role of the calcaneus in relation to the plantar fascia, tendons, and ligaments?

Besides the subtalar joint, which facets of the calcaneus articulate with the talus?

Which of the following best represents the proportion of tarsal fractures that are calcaneal fractures?

Which of the following is NOT a primary morphological concern when addressing calcaneal fractures?

Articular incongruity following a calcaneal fracture primarily involves which joints?

What is the typical initial post-operative protocol regarding weight bearing after calcaneal fracture surgery?

What is considered the number one predictor of poor outcome from calcaneus fracture?

Which of the following is stated as a benefit of minimally invasive approaches to calcaneal fracture fixation, when compared to traditional extensile approaches?

During a traditional lateral extensile approach for a calcaneal fracture, which structure is NOT typically included within the skin flap?

What is the primary goal when addressing the 'shortening' deformity of a calcaneal fracture?

Which of the following is an indication for using the sinus tarsi approach for calcaneal fracture fixation?

Besides the calcaneocuboid joint, which other articulation is a primary concern for articular incongruity in calcaneal fractures?

What key feature is intended to be corrected by addressing the 'shortening' component of a calcaneal fracture?

During reduction of a calcaneal fracture, moving the tuberosity fragment medially will correct which deformity?

What is the primary soft tissue complication specifically mentioned as significant in calcaneal fractures?

What is the primary approach to indirectly reduce the sustentaculum tali during calcaneal fracture fixation?

Which of the following is NOT used for K-wire retraction during the traditional lateral extensile approach?

In the context of calcaneal fracture reduction, what does addressing 'varus' primarily involve?

A surgeon is correcting the morphology of a calcaneal fracture. What are the main aspects of morphology they need to consider?

Which of the following best describes the 'double density' sign seen in calcaneal fractures?

A decrease in Böhler's angle on a lateral radiograph of the calcaneus suggests:

Which anatomical issue is addressed by the 'Joint Depression-Sinus tarsi Approach'?

What is the typical range for the critical angle of Gissane?

In the Essex-Lopresti classification, what main anatomical feature are we primarily assessing?

When considering 'morphology' during a 'Joint Depression-Sinus tarsi Approach', which specific aspects are targeted for correction?

The Harris Beath axial view of the calcaneus is best for assessing which of the following?

In the context of the 'Joint Depression-Sinus tarsi Approach', what does 'articular incongruity' refer to?

In Broden's views, what degree of internal rotation of the leg is required when taking x-rays?

What is the immediate post-operative weight-bearing protocol following the 'Joint Depression-Sinus tarsi Approach'?

After the initial non-weight bearing period with a splint, what is the following phase of rehabilitation?

According to the Sanders classification, a Type 3AC fracture indicates:

Which type of fixation is explicitly mentioned as being used in conjunction with the corrections?

What does the Sanders classification utilize to categorize calcaneal joint depression fractures?

What specific Sanders classification is referenced when using 'Percutaneous Fixation'?

Besides correcting deformities in morphology and shortening, which other primary aspect is addressed?

According to the Rowe classification, a fracture of the sustentaculum tali is classified as which type?

In the management of calcaneal fractures using percutaneous reduction with ring fixation, which of the following is explicitly stated as being not a primary concern?

Which of the following Rowe classifications describes a fracture that spares the Achilles tendon insertion?

A patient has a calcaneal fracture resulting from a twisting fall on a supinated foot. Based on the Rowe classification, which specific injury is MOST likely suspected?

According to the goals for calcaneal fracture surgery as stated in the provided text, which of the following is a primary objective?

During a traditional lateral extensile approach, which anatomical structure is NOT directly retracted using K-wires?

Which of the following Rowe classifications is most commonly associated with a fall from height with the heel in a varus or valgus position, NOT involving the subtalar joint?

When correcting for 'shortening' in a calcaneal fracture, which specific dimensional aspects are addressed?

According to the provided surgical technique using ring fixation, what is the primary goal of distracting the joints?

A fracture involving the Achilles tendon insertion is MOST likely classified as which of the following according to the Rowe classification?

In addressing the tuberosity fragment of a calcaneal fracture. Which of the following is specifically corrected by moving the fragment medially?

What is the primary objective of correcting the 'varus' deformity in calcaneal fracture reduction?

Which anatomical structure is indirectly reduced during calcaneal fracture management, according to the provided text?

During the lateral extensile approach, the skin flap contains specific anatomical structures. Which of the following is NOT typically included in this flap?

What is the primary concern associated with 'articular incongruity' following a calcaneal fracture, as outlined in the provided text?

Besides 'shortening' and 'morphology', what other primary aspect is necessary to correct when addressing a calcaneal fracture.

Which of the following best describes the calcaneus's role in weight-bearing mechanics?

Which statement accurately represents the structural relationship between the sustentaculum tali and its function?

What is the primary implication of the posterior facet's downward slope from lateral to medial?

Which of the following best captures the stated view on long-term outcomes of calcaneal fractures?

What is suggested in the information provided about the challenges associated with treating calcaneal fractures ?

Based on the information, what patient demographic is most likely to experience calcaneal fractures?

Which characteristic of the calcaneus is described as counteracting compressive forces during weightbearing?

The middle and anterior facets of the calcaneus are described as:

Which of the following is a characteristic of the calcaneal tuberosity's displacement in an intra-articular fracture?

According to the provided data, what is the approximate difference in the percentage of patients with good or excellent long-term outcomes using the Iowa Calcaneal Scale (ICS), when comparing 10-year and 20-year follow-up results of non-operatively treated calcaneal fractures?

In non-operative treatment, following initial splinting, when is it typically recommended to transition to a cast or fracture boot, and begin gentle range of motion exercises?

Which of the following is NOT a generally accepted indication for operative treatment of calcaneal fractures, based on the presented information?

According to the information provided, what is the primary rationale for delaying calcaneal fracture surgery by 2 to 3 weeks post-injury?

When correcting calcaneal morphology using the sinus tarsi approach, what does addressing 'width' specifically aim to achieve?

In the context of calcaneal fracture reduction utilizing the sinus tarsi approach, which of the following best describes the treatment focus when addressing 'shortening'?