Calcaneal fractures

NewsBot · Oct 19, 2024

A Scoping Review: How should fractures of the Anterior Process of the Calcaneus be managed in athletes?
Joseph Franklin, Charles Offer
doi: https://doi.org/10.1101/2024.10.18.24315738

Lay Summary The Anterior Process of the Calcaneus is part of the heel bone (calcaneus), located near to where this bone meets the Navicular bone. Both bones are in the foot. The main mechanism that causes this injury, in the sporting context, is an avulsion injury. Essentially, a ligament, that attaches the calcaneus to the navicular, is pulled with such force that it pulls off some of the attached calcaneus bone. Commonly this occurs when athletes roll their ankles. Historically, these fractures have often been misdiagnosed, with fractures being mistaken for bad sprains and soft tissue damage. This misdiagnosis has led to the mismanagement of these injuries with poor patient outcomes and recovery. Despite growing amounts of guidance available, there is still a lack of clarity in the literature. This is particularly the case in how this injury should be managed in the athlete looking to return to sport. This review seeks to analyse the preexisting guidance in the management of these injuries, pulling resources together, to better direct the clinician and improve patient/athlete outcomes. This review will also highlight areas where more research is needed.
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NewsBot · Oct 26, 2024

Short term efficacy of subtalar arthroscopy combined with medial calcaneal-talar joint distraction in minimally invasive treatment of diabetic patients with calcaneal fractures: a retrospective study
Xiaoyu Dai et al
BMC Musculoskelet Disord. 2024 Oct 25;25(1):849. doi: 10.1186/s12891-024-07960-7.

Background: The surgical treatment and management of postoperative soft tissue complications in diabetic patients with displaced calcaneal fractures are still controversial. We aimed to evaluate the short-term efficacy of percutaneous minimally invasive screw fixation in treatment of diabetic patients with Sanders II and III calcaneal fractures under subtalar arthroscopy assisted by preoperative musculoskeletal ultrasonic locating lateral calcaneal branch (LCB) of the sural nerve and calcaneal-talar joint distraction device.

Methods: The clinical data of 52 diabetic patients diagnosed with Sanders II or III calcaneal fractures from March 2016 to August 2020 were followed up and analyzed. There were 23 patients of type II and 29 patients of type III, 34 males and 18 females, with a mean age of 61.7 ± 14.5 years (range: 45-72 years). Preoperative musculoskeletal ultrasonography was routinely examined to locate LCB of the sural nerve. During surgery, we performed arthroscopic percutaneous prying reduction screw fixation assisted by medial calcaneal-talar joint distraction. Incision healing, local skin paraesthesia and other conditions were observed regularly at 3 days, 6, 12 months, and the last follow-up after surgery. Also, we measured the length, width, height, Böhler angle, and Gissane angle of the calcaneus on lateral and axial x-rays. Visual analogue pain scale (VAS), American Orthopedic Foot and Ankle Society (AOFAS) score and Maryland score were used to evaluate the efficacy.

Results: 52 patients were followed up for 23.7 ± 3.2 months (range: 20-28 months) without incision-related complications. Calcaneal radiographic parameters (length, width, height, Böhler/Gissane angle) were improved after surgery, and the differences were all statistically significant (P<0.05). There was no difference between calcaneal radiographic parameters at 6,12 months and the last follow-up compared with 3 days after surgery without significant loss in overall morphology (P>0.05). Postoperative VAS, AOFAS scores, and Maryland scores were significantly improved compared with those before surgery (P<0.05).

Conclusions: Preoperative ultrasonic locating LCB of the sural nerve and arthroscopic percutaneous minimally invasive screw fixation of Sanders II and III calcaneal fractures with the assistance of calcaneal-talar joint distraction have good short-term efficacy and clinical feasibility in diabetic patients.
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NewsBot · Oct 29, 2024

Effectiveness of accelerated rehabilitation surgical nursing on perioperative outcomes in patients with calcaneal fractures
Qian Xie 1, Bin Zhao, Zhenhua Fang
Medicine (Baltimore). 2024 Oct 11;103(41):e39409

This study aims to evaluate the impact of accelerated rehabilitation nursing on perioperative outcomes in patients with calcaneal fractures. A total of 101 patients with calcaneal fractures admitted from December 2020 to December 2022 were included in this study. Patients were randomly assigned to an observation group (OG) of 51 patients receiving accelerated rehabilitation surgical nursing and a control group (CG) of 50 patients receiving conventional surgical nursing. Outcomes assessed included patient satisfaction, visual analog scale (VAS) scores before and after surgery, swelling reduction time, and complication rates. The satisfaction rate in the OG was 96.07%, significantly higher than the 80.00% observed in the CG. Post-operative VAS scores at day 4 and 6 were significantly lower in the OG compared to the CG. Swelling reduction time was shorter in the OG (152.56 ± 25.22 hours) compared to the CG (170.76 ± 22.51 hours). Additionally, the complication rate in the OG was significantly lower at 7.84% compared to 24.00% in the CG (P < .05).the implementation of accelerated rehabilitation nursing significantly shortened the average length of hospital stay for patients in the observation group. In contrast, patients in the control group, who received conventional nursing care, had a relatively longer hospital stay. In the perioperative treatment of calcaneal fractures, accelerated rehabilitation surgical nursing can significantly improve patient satisfaction, reduce pain, shorten the time for swelling to subside, and lower the incidence of complications. Additionally, it can shorten the hospital stay for patients, demonstrating its efficacy and potential for broader clinical application.
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NewsBot · Nov 13, 2024

Calcaneus Fractures, Epidemiology and Treatment– data on 3 949 fractures from the Swedish Fracture Register
Anna Rubenson et al
Foot and Ankle Surgery; 13 November 2024

Background
Due to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment.
Methods
The study is based on data from the Swedish Fracture Register and include patients ≥18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n=320, could be identified and were studied in a separate analysis.
Results
The study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60%) were men. Fall from height was the most common mechanism of injury (n=1683; 46%) and high-energy trauma was documented in 887(28%) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n=1105; 89%) and B (n=717; 93%) fractures were treated non-surgically, while surgical treatment was more common in type C (n=499; 43%) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used.
Of the patients with bilateral fractures 80% were male, (n=128). They were generally younger (mean age of 38 years (SD±14.5, p<0,001) and had a larger proportion of high-energy traumas, n=107 (67%) compared with patients with unilateral fractures.
Conclusion
Calcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically.
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NewsBot · Nov 15, 2024

Calcaneus Fractures, Epidemiology and Treatment– data on 3 949 fractures from the Swedish Fracture Register
Anna Rubenson et al
Foot and Ankle Surgery; 13 November 2024

Abstract
Background
Due to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment.
Methods
The study is based on data from the Swedish Fracture Register and include patients ≥18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n=320, could be identified and were studied in a separate analysis.
Results
The study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60%) were men. Fall from height was the most common mechanism of injury (n=1683; 46%) and high-energy trauma was documented in 887(28%) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n=1105; 89%) and B (n=717; 93%) fractures were treated non-surgically, while surgical treatment was more common in type C (n=499; 43%) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used.
Of the patients with bilateral fractures 80% were male, (n=128). They were generally younger (mean age of 38 years (SD±14.5, p<0,001) and had a larger proportion of high-energy traumas, n=107 (67%) compared with patients with unilateral fractures.
Conclusion
Calcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically.
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NewsBot · Nov 19, 2024

Permissive weight bearing versus restrictive weight bearing in surgically treated trauma patients with displaced intra-articular calcaneal fractures (the PIONEER study): study protocol for a multicenter randomized controlled trial
Coen Verstappen et al
Trials. 2024 Nov 18;25(1):778.

Background: Following successful treatment, displaced intra-articular calcaneal fractures (DIACFs) necessitate an extensive rehabilitation regimen, significantly influencing functional and socio-economic outcomes. Apart from surgical intervention, the implementation of a comprehensive rehabilitation protocol is crucial to optimize foot stability and functional recovery. The objective of this study is to ascertain the optimal rehabilitation protocol for patients with surgically treated DIACFs, either permissive weight bearing (PWB) or Restricted Weight Bearing, focusing on functional outcomes, health-related quality of life (HRQoL), radiographic parameters, cost-effectiveness, and incidence of complications.

Methods: Study design: A prospective multicenter randomized controlled trial.

Study population: Presence of surgically (extended lateral, sinus tarsi, or percutaneous approach) treated unilateral DIACFs (Sanders type II to IV), aged 18-67 years (labor force). Patients must be able to understand and follow weight bearing instructions. N = 115 patients with DIACFs will be included.

Interventions: Patients with DIACFs will be randomly allocated to one of the rehabilitation protocols, either PWB or RWB.

Primary outcome measure: Functional outcome, measured with the American Orthopaedic Foot & Ankle Society Score (AOFAS)).

Secondary outcomes: Functional outcome (Maryland Foot Score, MFS), HRQoL (EuroQol-5D, EQ-5D), differences in radiographic parameters, cost-effectiveness, and complications. Nature and extent of burden: The PWB protocol is aimed to be non-inferior to the RWB protocol. Previous analysis of this protocol in other lower extremity fractures has shown a safe complication rate. Follow-up is standardized according to current trauma guidelines, namely at time points 2, 6, 12 weeks, and 6 months. The radiation exposure for both groups will differ from standard care (one extra CT scan of the foot will be made). Therefore, the burden for participants is considered minimal, with no significant health risks.

Discussion: This study will be the first study to define an optimal rehabilitation regime for surgically treated patients with DIACFs. The limitations of this study include the absence of patient blinding, as this is impossible in rehabilitation. Additionally, the primary outcome measure (AOFAS) has limited validity for DIACFs. However, it is the most commonly used questionnaire in the literature on DIACFs. There is an apparent need since current literature is lacking on this specific topic.
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NewsBot · Nov 26, 2024

Calcaneus fractures, epidemiology and treatment - Data on 3 949 fractures from the Swedish Fracture Register
Anna Rubenson et al
Foot Ankle Surg. 2024 Nov 13:S1268-7731(24)00237-6

Background: Due to changing population demographics and evolving treatment strategies updated epidemiological data are needed. This study aims to provide nationwide epidemiology data regarding calcaneus fractures of all types and treatment.

Methods: The study is based on data from the Swedish Fracture Register and include patients ≥ 18 with a calcaneus fracture sustained between April 2012 and June 2022. Patient characteristics, injury mechanism, fracture classification and primary treatment were analysed. With access to data on each separate fracture, all bilateral fractures, n = 320, could be identified and were studied in a separate analysis.

Results: The study included 3629 unilateral calcaneus fractures in 3618 patients. The mean age was 48 years (SD ± 18) and 2178 (60 %) were men. Fall from height was the most common mechanism of injury (n = 1683; 46 %) and high-energy trauma was documented in 887(28 %) patients. Overall, AO/OTA type A fractures (avulsion), and type C fractures (intra-articular) was equally common, but the type C fracture was the most common fracture type in men. The vast majority of type A (n = 1105; 89 %) and B (n = 717; 93 %) fractures were treated non-surgically, while surgical treatment was more common in type C (n = 499; 43 %) fractures. Fracture fixation with plate and screws was the most common surgical method. Arthrodesis as a primary treatment was rarely used. Of the patients with bilateral fractures 80 % were male, (n = 128). They were generally younger (mean age of 38 years (SD±14.5, p < 0001) and had a larger proportion of high-energy traumas, n = 107 (67 %) compared with patients with unilateral fractures.

Conclusion: Calcaneus fractures occur most frequently in the middle-aged population, and the majority of patients are male. The difference in prevalence between men and women is less pronounced than previous studies have shown. In male patients the fractures were more severe, more often caused by high-energy trauma, and more frequently treated surgically.
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NewsBot · Dec 3, 2024 at 7:20 PM

Mid-term results of intra-articular calcaneal fractures treated with minimally invasive two-point distractor : Single center study with 6-year follow-up
Matthias Stark et al
Wien Klin Wochenschr. 2024 Dec 2

Background: Displaced intra-articular calcaneal fractures are a complication-ridden injury to treat and there are various treatment techniques to address this injury. The aim of this study was to evaluate the mid-term outcome of a percutaneous two-point distractor technique in patients with displaced intra-articular calcaneal fractures.

Methods: A retrospective data analysis of patients with intra-articular calcaneal fractures treated in a level 1 trauma center was conducted. The patients were subsequently invited for a follow-up visit to assess the mid-term outcome. The Böhler's and Gissane's angles, the American Orthopaedic Foot & Ankle Society hindfoot score, the Maryland foot score and a visual analog scale for pain were measured preoperatively and postoperatively and after at least 6 years to assess the radiological and functional outcome.

Results: Of the patients 59 completed the study with a mean follow-up of 76 months after surgery. The mean American Orthopedic Foot and Ankle Society hindfoot score at the last follow-up visit was 81, the mean Maryland foot score was 78. There were three cases (5%) of superficial wound complications and secondary arthrodesis of the subtalar joint was performed in five patients (8%).

Conclusion: The low rates of postoperative infections and secondary arthrodesis in this study underline the good to excellent mid-term functional results for a minimally invasive technique.
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NewsBot · Dec 4, 2024 at 8:10 PM

Gait assessment in patients with intra-articular calcaneal fractures after treatment with the Ilizarov method
Marcin Pelc et al
Injury. 2024 Nov 27;56(2):112070

Background: Intra-articular and comminuted fractures of the calcaneus constitute a significant orthopedic challenge. Calcaneal fracture management should primarily aim to achieve good clinical and biomechanical outcomes, pain reduction, and normal function following treatment.

Research question: How does Ilizarov treatment of calcaneal fractures affect gait parameters?

Methods: This retrospective study included 21patients (7 women, 14 men) who were treated for intra-articular calcaneal fractures with the Ilizarov method in the period 2021-2022. Nineteen healthy volunteers constituted the control group. Gait assessments were conducted with a BTS G-SENSOR device (BTS Bioengineering Corp., Quincy, MA, USA). The gait assessment evaluated the following parameters: assessment duration expressed in seconds (s), cadence expressed as the number of steps per minute (steps/min), gait velocity (m/s), stride length (m), stance phase (%), swing phase (%), double support phase (%), and single support phase (%).The study assessed pain intensity in the VAS scale, Böhler's angle and Gissane's angle.

Results and significance: We observed no significant differences between the experimental group and the healthy control group in terms of cadence, gait velocity, or stride length. Patients in experimental group showed significantly shortened stance and single support phases in the treated limb in comparison with those in the intact limb; the remaining gait parameters were similar in the treated and intact limb. We observed no significant differences between the treated limbs in the patient group and the nondominant limbs in the control group in terms of any gait parameters. In the follow-up, the average pain value on the VAS scale was 2.3. The median Böhler angle changed from 5.5° preoperatively to 28.5° postoperatively, p < 0.001. The median Gissane's angle was 119° before surgery and 143° after surgery, p < 0.001.The use of the Ilizarov method in the treatment of calcaneal fractures helps achieve sufficient normalization of most gait parameters, with their values similar to those observed in healthy volunteers. After treatment of calcaneal fractures using the Ilizarov method, radiological parameters improved. The biomechanical outcomes of calcaneal fracture treatment with the Ilizarov method are good.
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Calcaneal fractures

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Psychological dysfunction following calcaneal fractures

Calcaneal stress fractures in minimalist/barefoot runners

Inaccuracies in the public advertising about calcaneal apophysitis

Calcaneal spur and its correlation with the talar articular facets

Calcaneal morphology and plantar fasciitis

Calcaneal spur and vitamin D, lipid profile and calcitonin

Painful Calcaneal Spur Often Misdiagnosed for Lumbar Radicular Pain

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Calcaneal fractures

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Psychological dysfunction following calcaneal fractures

Calcaneal stress fractures in minimalist/barefoot runners

Inaccuracies in the public advertising about calcaneal apophysitis

Calcaneal spur and its correlation with the talar articular facets

Calcaneal morphology and plantar fasciitis

Calcaneal spur and vitamin D, lipid profile and calcitonin

Painful Calcaneal Spur Often Misdiagnosed for Lumbar Radicular Pain

Share This Page

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