What Is a Calcaneus Fracture?

Calcaneal fractures are characterized by severe heel pain, swelling and ecchymosis, inability to walk on the heel, and calcaneal tenderness. Adults with this disease are more common, often falling or being crushed. Frequently accompanied by spinal fractures, pelvic fractures, head, chest, and abdominal injuries. The calcaneus is cancellous, and the blood supply is relatively abundant, and those with nonunion are rare. However, if the fracture line enters the articular surface or the reduction is not good, post-traumatic arthritis and pain in the calcaneus are very common.

Basic Information

English name: fracture of calcaneus
Visiting department: orthopedics
Common locations: Heel

Common causes: Mostly caused by falling from a height, landing on the foot, and a vertical impact on the heel
Common symptoms: Heel pain, unable to stand and walk

Causes of calcaneal fractures

Calcaneal fractures are most common in patella fractures, accounting for about 60% of all patella fractures. Mostly caused by falling from a high place, landing on the foot, the heel was subjected to a vertical impact.

Longitudinal fracture of calcaneal tuberosity

When the fall is high, the heel eversion nodules touch the ground, and the inner bulges of the nodules are caused by external shear forces. It rarely shifts and generally does not require processing.

2. Calcaneal tuberosity (bird's beak) fracture

A type of avulsion fracture of the Achilles tendon. If the avulsion bone is small, it will not affect the function of the Achilles tendon. If the fracture piece exceeds 1/3 of the nodule, and there is rotation and severe tilt, or severe upward pull, the operation can be reset and screw fixed.

3. Fracture of the calcaneus

In the case of inversion of the foot, the load-bearing process is rarely caused by the impact of the talus below. Generally, there is not much displacement. If there is displacement, you can push it back to the original position and fix it with short leg plaster for 4 to 6 weeks.

4. Anterior calcaneal fracture

Rarely. The injury mechanism is strong adduction of the forefoot plus plantar flexion. An X-ray oblique film should be taken to rule out a fracture of the anterior superior calcaneus tear. A short leg cast can be fixed for 4 to 6 weeks.

5. Fractures close to the calcaneus

For the fracture of the calcaneal body, the injury mechanism is also caused by falling from the calcaneus to the ground or the heel receiving a reverse impact force from below. The fracture line is oblique. The front view of the X-ray film shows that the fracture line is obliquely forward and backward from the inside, but does not pass through the heel-talar joint surface. Because the calcaneus is cancellous, the view of the axis is widened on both sides of the calcaneus; in the lateral position, the posterior half of the calcaneus and the calcaneal nodules are shifted backwards and upwards, so that the abdomen of the calcaneus protrudes toward the center of the foot Into a rocking chair.

Clinical manifestations of calcaneal fractures

Patients with this disease mainly have the following manifestations:

1. Heel pain after trauma, can't stand and walk.

2. Local swelling, tenderness, deformity, or bone fricatives.

Calcaneal fracture examination

X-ray plain films (including ortho, lateral and calcaneal axis radiographs) can generally be used for clear diagnosis. CT scan or MRI can be used for those who are difficult to diagnose, especially CT scan has a greater role in the diagnosis and prognosis of the fracture classification . The auxiliary examination methods for this disease are mainly imaging examinations.

Diagnosis of calcaneus fracture

The heel of the patient can be extremely swollen, the posterior sulcus of the ankle becomes shallow, and the entire hind foot is swollen and tender. X-ray examination, in addition to taking lateral radiographs, should take calcaneal axial image to determine the type and severity of fractures. In addition, the calcaneus belongs to cavernous bone, and there is often no clear fracture line after compression, and sometimes it is not easy to distinguish. It is often necessary to analyze the severity of the fracture based on changes in the shape of the bone and measurement of the nodule-joint angle. Only individual cases require CT or MRI.

Treatment of calcaneal fractures

Non-surgical treatment

(1) Non-displaced calcaneal fractures, including those with fracture lines leading to the joint, are braked with a calf plaster support for 4 to 6 weeks. After clinical healing, the plaster is removed and bandaged to promote swelling subsidence. Do functional exercises at the same time. However, walking down the ground should not be premature. Generally, walking down the ground 12 weeks after the injury.

(2) Fractures with displacements such as longitudinal split of the calcaneus, avulsion fractures of the calcaneal tuberosity, and fractures of the calcaneus talus. It can be manually reset under anesthesia, and then fixed in the functional position with calf plaster for 4 to 6 weeks. The posterior nodule fracture needs to be fixed in the plantar flexion position.

(3) Functional compression is used for severe compression comminuted fractures in the elderly over 60 years old . That is, after 3 to 5 days of rest, use elastic bandages to bandage the local area, and then perform functional exercises, supplemented by physiotherapy and massage.

2. Surgical treatment

(1) Those with calcaneal tongue fractures, transverse fractures of the calcaneal body that affect the joints and displacement, can be pried with a round bone needle under anesthesia, and then fixed to the mild plantar flexion with calf plaster for 4-6 weeks.

(2) Transverse transverse calcaneal fractures, tongue fractures, and fractures of the posterior calcaneal tuberosity should be resected open and reduced, and internally fixed with compression screws. Postoperative plaster was fixed in the functional position for 4-6 weeks.

(3) Compression fractures and even comminuted fractures of the calcaneus in young and middle-aged people. Some people advocate early incision and bone reduction to restore the general shape of the calcaneus and the longitudinal arch of the foot. With or without internal fixation as needed, postoperative fixation with calf plaster for 6 to 8 weeks.

(4) Severe comminuted fracture of the calcaneus Some people advocate early joint fusion, including calcaneal distance and calcaneal joint. However, most people advocate functional therapy first to promote the resolution of edema and prevent adhesion of tendons and joints. When complications occur at a later stage, three-foot joint fusion is performed.

(5) Surgery method Bone-needle pry reduction and fixation; Incision and reduction of compression screw internal fixation; Incision and reduction and bone transplantation; Joint fusion;

3. Rehabilitation

Regardless of surgery or not, active activities of the quadriceps and toes should be performed during the plaster fixation. After the plaster has been removed, the fracture has healed or the joints have been fused, and the ankle and foot functions should be actively exercised, including the application of equipment.