A kalkaneal fracture is a break from the calcaneus (heel bone). Symptoms may include pain, bruising, difficulty walking, and heel deformity. This may be related to hip or back rest.
Usually occurs when a person lands on their feet after falling from a height or during a motor vehicle crash. Diagnosis is suspected based on symptoms and confirmed by X-ray or CT scan.
If the bones remain treated normally it is possible with a casting without heavy load for about eight weeks. If surgical bones are not aligned it is usually necessary. Returning bone to normal position produces better results. Surgery may be delayed for several days as long as the skin remains intact.
Approximately 2% of all fractures are kalkaneal fractures; however, they make up 60% of middle leg bone fractures. Undisplaced fractures can heal in about three months while more significant fractures can take two years. Difficulties such as arthritis and decreased range of footwork may persist.
Video Calcaneal fracture
Signs and symptoms
The most common symptom is pain in the heel area, especially when the heel is touched or squeezed. Patients usually have a recent history of trauma to the area or fall from a height. Other symptoms include: inability to bear weight over the involved foot, limited leg mobility, and limping. After review, the examiner may notice swelling, redness, and hematoma. The hematoma extending into the soles of the feet is called "Mondor Sign", and is pathognomonic for calcaneal fractures. The heel can also widen with associated edema due to lateral kalkaneal border displacement. Soft tissue involvement (tendons, skin, etc.) Should be evaluated because soft tissue injury has been associated with serious complications (see below).
Maps Calcaneal fracture
Cause
Calcaneal fractures are often associated with shear stresses adjacent to compressive forces combined with the direction of rotation (Soeur, 1975). These forces are usually associated with injuries in which a person falls from a height, involvement in a car accident, or muscle stress in which the resulting power can cause a fracture trauma. The neglected aspect of what can cause calcaneal fractures is the role of osteoporosis and diabetes.
Unfortunately, fall prevention and car accidents are limited and apply to unique circumstances that should be avoided. The risk of muscle stress fractures can be reduced through stretching and weight-bearing exercises, such as strength training. In addition, footwear can affect the forces that can cause calcaneal fractures and can prevent them as well. A 2012 study conducted by Salzler showed that an increased tendency toward minimalist footwear or running footwear can cause various stress fractures including those that occur in the calcaneus.
Osteoporosis
Bone mineral density decreases with increasing age. Bone loss osteoporosis can be prevented through adequate vitamin C and vitamin D intake, coupled with exercise and by becoming nonsmokers. A study by Cheng et al. in 1997, suggesting that greater bone density suggests a smaller risk for fractures in the calcaneus.
Diabetes
In 1991, Kathol conducted a study that showed a correlation between avulsion fractures of calcaneal insufficiency (fractures in which the Achilles tendon removes some of the bone during rescinds) and diabetes mellitus. The population of diabetes is more susceptible to fracture risk and potential healing complications and infections that can lead to amputation of limbs. Diabetes can be regulated and prevented through diet and exercise.
Diagnosis
Conventional radiography is usually an early assessment tool when calcaneal fracture is suspected. Recommended x-ray images are (a) axial views, (b) anteroposterior, (c) and (d) with dorsiflexion and internal rotation of the foot. However, conventional radiography is restricted to the visualization of a kalkaneal anatomy, especially in the subtalar joint. CT scans are currently the preferred imaging study to evaluate calcaneal injury and have replaced conventional radiography in the classification of calcaneal fractures. The axial and coronal appearance is obtained for proper visualization of the calcaneus, subtalar, calcaneocuboid and talonavicular joints.
Classification
The calcaneus, also known as the heel bone, is the largest tarsal bone and articulates with the anterior bone of the cuboid and the superior talus bone. It is responsible for transmitting most of the body weight from the talus bone to the ground.
Calcaneal fractures are categorized as intraarticular or extra-articular on the basis of subtalar joint involvement. Intra-articular fractures are more common and involve the posterior talar articular side of the calcaneus. Classification Sanders group these fractures into four types based on the location of the fracture on the posterior articular surface. Extra-articular fractures are less common and can be found anywhere outside the subtalar joint. An extra-articular fracture is categorized depending on whether the calcaneus involvement is anterior (Type A), middle (Type B) or posterior (Type C).
The Gissane angle, or "Critical Angle", is the angle formed by the downward and upward slopes of the superior surface of the calcaneal. On lateral radiography, Gissane angle & gt; 130 Â ° shows posterior subtalar joint surface fracture. The Bohler Angle, or "Tuber Angle", is another normal anatomical marker visible on lateral radiographs. It is formed by intersection 1) the line from the highest point of the posterior articular side to the highest point of the posterior tuberosity, and 2) the line from the first to the highest point on the anterior articular facet. Bohler's angle is usually 25 Â ° to 40 Â °. A decreasing angle represents calcaneal fracture.
The Sanders classification system is the most commonly used system for categorizing intra-articular fractures. There are 4 types:
- Type I fracture is a non-displaced fracture (displacement & lt; 2 mm). Type II fractures consist of a single intra-articular fracture that divides the calcaneus into 2 parts.
- Type IIA: fracture occurs on the lateral aspect of the calcaneus.
- Type IIB: fracture occurs in the central aspect of the calcaneus.
- IIC type: fracture occurs in the medial aspect of the calcaneus.
- Type IIIAB: two existing fracture lines, one lateral and one center.
- Type IIIAC: two lines of fracture exist, one lateral and one medial.
- Type IIIBC: two existing fracture lines, one center and one medial.
- Type IV fractures consist of fractures with more than three intra-articular fractures.
Extra-articular fractures cover all fractures that do not involve the posterior side of the subtalent joint.
- Type A involves anterior calcane
- Type B involves middle cube. These include rope sustentaculum, trolear and lateral processes.
- Type C involves posterior cauldron, posterior tuberculosis and medial tuberculosis including.
Treatment
Non-surgical treatments are for extra-articular fractures and Type I intra-articular fractures, provided that the surface load and leg function of the calcaneis are not disturbed. Doctors may choose to perform closed reduction with or without fixation, or fixation only (without subtraction), depending on each case. Recommendations include not weight-bearing for several weeks followed by motion range exercises and progressive weight bearing for a period of 2-3 months.
Disturbed intra-articular fractures require surgical intervention within 3 weeks of fracture, prior to bone consolidation. Conservative surgery consists of a closed reduction with percutaneous fixation. This technique is associated with fewer wound complications, better soft tissue cure (due to fewer soft tissue manipulates) and decreased intraoperative time. However, this procedure increases the risk of inadequate calcaneal bone fixation, compared with open procedures. Currently, open reduction with internal fixation (ORIF) is usually the preferred surgical approach when handling intra-articular fractures that move. Newer and more innovative surgical techniques and equipment have reduced the incidence of intra and postoperative complications.
Rehabilitation
Rehabilitation for calcaneal fractures depends on whether surgery is necessary or not. Both types of rehabilitation require three phases where only the first phase is different.
Exercises that can be used for the mobile phase range can include eversion and ankle inversion, flexion and ankle extension, and a combination of two movements to create circular foot movements. Exercises that allow a little full weight to be used in the final phase include stepping forward then back, side-stepping, and standing feet.
Phase
The first phase of rehabilitation after surgery includes keeping the feet elevated and ice for the first 2 days after surgery. After 2 days, using crutches or wheelchairs where no weight is applied to the affected foot is recommended to get around. If no surgery is performed, the feet should be submitted to frequent range of motion exercises. The second phase occurs 6 weeks after and consists of keeping the feet up and ice while resting and doing exercises where only a little weight is applied to the affected area for the next two weeks; others recommend six weeks of this phase. In this phase, range of motion exercises should be performed if surgery is required for the fracture. The third and final phase of rehabilitation of the calcaneal fracture is to allow full weight to be used and use crutches or sticks if needed, between 13 weeks to a year the patient is allowed to resume normal activity.
Complications
Evaluating soft tissue involvement is the most important aspect of clinical examination because of its relationship to patient outcomes. Skin blisters can become infected if medical attention is delayed, which can cause necrotizing fasciitis or osteomyelitis, causing permanent damage to the muscles or bones. Ligament and tendon involvement should also be explored. Achilles tendon injury can be seen with posterior fracture (Type C). Because calcaneal fractures are associated with falling from a height, other concurrent injuries should be evaluated. Vertebral compression fractures occur in about 10% of these patients. A traumatized clinical approach should be implemented; Tibial injuries, knees, femur, hips, and head should be ruled out through history and physical examination.
Society and culture
The name fractional lover comes from the fact that a lover can jump from a height while trying to escape from a lovers couple.
References
Bibliography
- Brant, W.; Helms, C (2007). Fundamentals of Radiological Diagnostics (3rd ed.). Lippincott Williams & amp; Wilkins. ISBNÃ, 0-7817-6135-2.
External links
Source of the article : Wikipedia
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