[1] It may be associated with breaks of the hip or back. A discrete fracture line, however, is not always seen. In: Tintinalli JE, Stapczynski JS, Cline DM, Ma OJ, Cydulka RK, Meckler GD, eds. Impact of percutaneous poking reduction combined with minimally invasive plate internal fixation on foot function and complications of patients with Sanders type II and III calcaneal fractures. Advances in cross-sectional imaging, particularly in computed tomography (CT), have given this modality an important role in identifying and characterizing calcaneal fractures. . The site is secure. PMC Fracture characterization is essential to guide the management of these injuries. FOIA J Orthop Surg Res. Displaced intra-articular fractures can further be described as tongue-type or depression-type. Accessibility Intra-articular 3. Calcaneal fractures are the most common tarsal fractures. [East Lancashire Foot and Ankle Hyperbook]. The fracture maps showed fracture patterns and recurrent fracture zones on all calcaneal surfaces. Before Traditionally, a burst fracture of the calcaneus was known as "Lovers Fracture" as the injury would occur as a suitor would jump off a lover's balcony (axial loading) to avoid detection. Major fracture lines and comminution were assessed by focusing on the posterior joint facet, medial wall, lateral wall, sustentaculum tali, and anterior process. On the posterior surface, the fracture lines appeared to be centered superiorly. Bohler's angle is normally 25 to 40. Surgeon. Lindsey Spiegelman, MD* and Mohammed Helmy, MD^, Correspondence should be addressed to Lindsey Spiegelman at lspiegel@uci.edu. HHS Vulnerability Disclosure, Help Would you like email updates of new search results? Dr. Foley accepts Aetna, Anthem and Blue Cross Blue Shield, and other major insurance plans. Computerized tomography scanning of acute intra-articular fractures of the calcaneus. -, Carr JB, Hamilton JJ, Bear LS. Calcaneal fractures account for up to 75% of all foot fractures and 1-2% of all fractures [ 1 ], being more common in males and those who work in an industrial profession. The Bhler angle is measured between a line drawn from the highest point of the anterior process of the calcaneus to the highest point of the posterior facet, and a line drawn tangential to the superior edge of the tuberosity and the posterior facet. There may be some pain, increasing . Computed tomography of calcaneal fractures: anatomy, pathology, dosimetry, and clinical relevance. Acta Chir Orthop Traumatol Cech. Figure 3: Tongue-type intra-articular fracture, lateral and Harris views, Extra-articular tongue-type fracture - this is a surgical emergency due to risk of pressure necrosis: extra-articular: 25-30% The stacked images of six calcaneus surfaces were also converted into spectrograms with MATLAB to highlight the fracture frequency at specific locations. Calcaneal fractures occur typically in adults who have undergone significant axial load on their feet secondary to a fall from high height.2,3 There are two broad types of calcaneal fractures: intraarticular and extraarticular.2 The intraarticular fractures are colloquially referred to as a Lovers Fracture as they have been known to occur in those jumping out of a tall window to escape the wrath of a lovers spouse.1 Calcaneal fractures are best diagnosed with a CT scan or with lateral x-ray by measuring Bhlers angle.2,3 This is the angle formed by the intersection of two lines demonstrated on a normal lateral ankle radiograph. If a calcaneus injury is found, look for concomitant fractures of the ankle and vertebrae. Joint depression fractures are those in which the secondary fracture line separates the lateral posterior facet from the body and tuberosity of the calcaneus. The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2 and ~60% of all tarsal fractures 3.. The old fracture line, however, is not accompanied by marrow edema on fluid-sensitive images. 2022. 2022 Nov 4. doi: 10.1007/s00264-022-05622-8. Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures. Calcaneal fractures are usually caused by high-energy trauma, such as a fall from height. Calcaneal fracture maps and their determinants. Extra-Articular calcaneal fractures, particularly in younger children are often managed non-operatively. BACKGROUND: This study was performed to investigate the relationship between coronal computed tomography (CT) and Broden's view in terms of location of the fracture line and fracture pattern. Bethesda, MD 20894, Web Policies Gitajn IL et al. What do they look like - clinically? 2020;59:11621166. Calcaneus fracture Contents 1 Background 1.1 Types 2 Clinical Features Differential Diagnosis Foot and Toe Fractures 3.1.1 Hindfoot 3.1.2 Midfoot 3.1.3 Forefoot 4 Evaluation General Fracture Management 5.2 Intra-articular fracture 5.3 Extra-articular fracture 6 See Also 7 Video 8 References Background Bones of the foot. Figure 28-2 The primary fracture line with the creation of two major fragments, the tuberosity and posterior facet segment (1) and the anterior process and sustentacular segment (2). A new classification system. 2019 Feb;37(2):483-489. doi: 10.1002/jor.24190. View details of top calcaneus fracture hospitals in Marine Lines, Mumbai. Published by Wiley Periodicals, Inc. Knee Surg Sports Traumatol Arthrosc. Experimental intra-articular calcaneal fractures: anatomic basis for a new classification. The fracture lines and zones of comminution were graphically superimposed onto an intact calcaneal template to identify fracture patterns. The second primary fracture line divided the calcaneus into anterior and posterior portions, beginning laterally at the angle of Gissane and extending medially (Fig. An angle of Gissane of more than 130 suggests a fracture of the posterior subtalar joint surface. Calcaneal fractures are serious injuries usually seen in patients who have landed on their feet after a long fall or who were in the front seat of a car during a motor vehicle collision when an excessive force crushes the heel bone against the talus. The diagnostic accuracy of Bhlers angle in fractures of the calcaneus. Calcaneal fractures have . Calcaneal fractures are associated with numerous complications and a poor prognosis with significant long-term quality-of-life issues, regardless of treatment. Required fields are marked *. CT measurement of the calcaneal varus angle in the normal and fractured hindfoot. 2016 Sep;59(9):958-64. doi: 10.1007/s11427-016-0010-9. In children, calcaneus fractures may be subtle and are often missed. [ 1] However, a true consensus regarding the management of these fractures has long eluded. Sign up to receive updates from JETem regarding newly published issues and findings. runners), 90% occur in men between 21 and 45 years of age with majority being industrial workers, Ecchymosis around heel extending to arch is highly suggestive, may also see fracture blisters, Compartment syndrome occurs in 10% of calcaneal fractures and can result in clawing of the toes after recovery (Egol 2010), Concomitant Achilles tendon rupture may be present, Calcaneal tuberosity (Achilles tendon avulsion). The calcaneus (heel bone) is responsible for transferring weight bearing forces from the ankle to the ground during standing, walking and running activities (figure 1). Describes comminution and displacement of the posterior facet by computed . He was repairing a window when he fell, landing on the ground 12 feet below. Accessibility Calcaneal fractures account for approximately 2% of all fractures seen in adults. The authors declare that they have no competing interests. In some other animals, it is the . A heel bone fracture can be severe, painful and debilitating. They are unable to bear weight on the affected leg. 2009;92:153167. Fractures of the calcaneus, or os calcis, have been observed and documented for centuries. If < 20 represents a calcaneal fracture (or more specifically a collapse of the posterior facet) The mechanism of injury can range from high energy trauma (falls from height) to low energy trauma (sport). Therefore, this method is valuable because it can provide an understanding of the pathomechanism of calcaneal fractures. -, Gougoulias N, Khanna A, McBride DJ, Maffulli N. Management of calcaneal fractures: systematic review of randomized trials. Intra-articular fractures have a worse prognosis and can be associated with severe heel widening, shoe wear problems, gait abnormalities, foot stiffness, and chronic pain. Calcaneal (heel bone) fractures often result from great force. Figure 4:: Calcaneal fracture lines for intra-articular fractures. Non-operative reduction in the Emergency Department is not indicated. doi: 10.1053/j.jfas.2020.04.006. The primary fracture line runs obliquely through the posterior facet forming two fragments. 2022 Jan 21;17(1):39. doi: 10.1186/s13018-022-02930-y. The right ankle lateral radiograph shows a comminuted, non-displaced fracture of the posterior calcaneus (red arrow) in addition to fracture fragments along the heel pad margin (blue arrow). Symptoms are worse with weight-bearing activities such as running and jumping. Extra-articular fractures have better outcomes and can be treated nonoperatively. 2 If the angle is less than 25 degrees then the interpreter should suspect a fracture (sensitivity 100%, specificity 82%), although a normal Bhler's angle does not exclude it. Displaced intra-articular fractures may require open reduction and internal fixation There were four concentrated bands of fracture lines and two fracture hot spots on the superior surface. 1. Calcaneal fractures can be divided broadly into two types depending on whether there is articular involvement of the subtalar joint 2,7,8:. Br Med Bull. Int Orthop. Calcaneal fractures are the most common tarsal fractures and represent approximately 2% of all fractures. J Emerg Med 2017.52 (1), 28-33PMID. The calcanei of five men and two women aged 44-77 years (average age, 60 years) with contralateral calcaneal fractures were analyzed. 4. In particular, displaced intra-articular fractures account for 60% to 75% of calcaneal fractures. Superior fracture map: a Grayscale image, b Full spectrum, geometric interval image, c, Inferior fracture map: a Grayscale image, b Full spectrum, geometric interval image: The, Medial fracture map. Superior Foot and Ankle Care . Therefore, we suggest that it is possible to reproduce calcaneal fractures using the finite element model. a Grayscale image, b Full spectrum, geometric interval image, c, Lateral fracture map. It's important to see your healthcare provider right away if you have a . Always suspect calcaneus fractures in patients with axial loading injuries to the lower extremities. Disclaimer, National Library of Medicine Fractures of the calcaneus: a review with emphasis on CT. 1989;10:8187. Keywords: Fracture mapping of intra-articular calcaneal fractures. 2000 Nov;86(7):724-36. Calcaneal stress fractures can cause intense pain and make walking more difficult. This trial simulated calcaneal fractures using a patient-specific computed tomography-based nonlinear finite element model. Where all parties agree that the fracture is non-displaced and extra-articular, follow up in the fracture clinic can be arranged in one week with a repeat x-ray. The fracture lines are opened at this time and may include temporary removal of . -, Daqiq O, Sanders FRK, Schepers T. How does mechanism of injury relate to similar fracture patterns in bilateral displaced intra-articular calcaneal fractures? Inversion and eversion of the injured foot are restricted. 2021;19(5):e222e229. 2005 Sep-Oct;25(5):1215-26. doi: 10.1148/rg.255045713. Fractures of the calcaneus represent about 1-2% of all fractures and 60% of the tarsal bones fractures ( 1 - 5 ). Pathology. 3 The mechanism of calcaneal injury is usually a fall, where an axial load. Epidemiology. 58. Fracture to the calcaneus is rare, with tarsal bones accounting for approximately 2% of all fractures, while Calcaneus Fractures account for 50-60% of those tarsal fractures. They specialize in Sports Medicine, has 35 years of experience, and is board certified in Orthopaedic Sports Medicine. Consultation with orthopaedics is advised for cases of calcaneus fracture diagnosed in the ED. Federal government websites often end in .gov or .mil. He denied any back pain, headache, or loss of consciousness. This goal was achieved by fracture maps created by copying and stacking fracture lines as viewed from six surfaces of the calcaneus. Please enable it to take advantage of the complete set of features! Please call ahead to confirm all accepted insurance plans. The Calcaneus bone (heel bone) sits on the base of the foot under the ankle joint, one of several tarsal bones, and along with the talus, it forms the hindfoot. Imaging. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. The calcaneus, the largest of the seven tarsal bones, is located on the lower back of the foot and forms the heel (heel of the foot) Calcaneal fractures are relatively rare, accounting for 1% to 2% of all fractures, but are important because they can lead to long-term disability. Bethesda, MD 20894, Web Policies Long term osteoarthritis in intra-articular fractures. Bhler's angle may help determine the loss of height. Huang ZH, Li J, Chen RQ, Du JW, Zhang JX. The fracture lines of the finite element model simulated the actual fracture lines and diagnosed joint depression types of fractures (five cases) and tongue types (two cases), but only under certain conditions for each case. The Angle of Gissane, also called "Critical Angle", is the angle formed by the downward and upward slopes of the calcaneal superior surface. The mean age of the patients was 46.3 years (standard deviation, 18.1; range, 15 to 80 years), and there . Definition: Fracture of the calcaneus bone Mechanism Traumatic axial loading is the most common cause (eg fall from height) Can also occur in MVCs when the accelerator/brake pedal impacts the foot Stress fractures seen with overuse from repetitive impact (e.g. A total of 210 consecutive patients with 226 calcaneal fractures were retrospectively analyzed. -, Gougoulias N, McBride D, Maffulli N. Outcomes of management of displaced intra-articular calcaneal fractures. Your email address will not be published. Angles < 20 degrees is suggestive of a calcaneus fracture and/or disruption of the posterior facet. 2 The normal angle is 25-40 degrees. . Delayed diagnosis when occurring with other major injuries in severe trauma. A calcaneus fracture is a condition characterized by a break in the heel bone of the foot, known as the calcaneus (figure 1). official website and that any information you provide is encrypted Many times, surgery is necessary to restore normal anatomy and mobility. This joint is important for normal foot function. Your doctor will examine your heel and foot, and get an x-ray to see if it is broken or not. An official website of the United States government. 2021 Nov 18;16(1):682. doi: 10.1186/s13018-021-02832-5. (2013) Calcaneal fractures. Calcaneus Fracture Is a Broken Heel Bone. The joint above the calcaneus, called the subtalar joint, is responsible for allowing the foot to rotate inward and outward. (See also Overview of Fractures .) Editorial Policy, Ethics and Responsibilities, Clinical Informatics, Telehealth and Technology. 2021 May 15;13(5):5329-5335. eCollection 2021. Vertebral fractures, tibial plateau fractures and additional foot fractures are often associated with calcaneus fractures. Patients with an acute calcaneal fracture present with an increasing swelling and pain over the heel. official website and that any information you provide is encrypted Calcaneus (Heel Bone) Fractures A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. The calcaneus is the greatest tarsal bone, and has the function of sustaining the body ( 1 ). There is still much debate regarding the position and direction of these fracture lines, even for the primary fracture line. doi: 10.1136/bmj.g4483. The first line is drawn between the superior aspect of the anterior process of the calcaneus (point A) and the superior edge of the posterior articular facet (point B). The kind of care taken influences the extent of recovery and restoration of foot function. runners) Epidemiology 2% of all fractures Most frequently fractured tarsal bone Calcaneus fractures may be intra-articular, involving the subtalar joint, or extra-articular. Note the decrease in Bohler's angle. Extra-articular 2. When this occurs, the heel can widen, shorten, and become deformed. [1] Symptoms may include pain, bruising, trouble walking, and deformity of the heel. Tsubone T, Toba N, Tomoki U, Arakawa D, Iiyama T, Hara N, Matsuo T, Fukuda F. J Orthop Res. Calcaneal fractures occur on the calcaneus or heel bone, a large bone that forms the foundation of the rear part of the foot. Foot and Ankle Injuries. 2014;349:g4483. Children being discharged with a calcaneal fracture should avoid bearing weight through the affected foot, at least up until the first review in fracture clinic. A calcaneus fracture is a fracture of the heel bone. Dr. Wylie Lowery, MD is a Sports Medicine Specialist in Woodbridge, VA. ; Line from the anterior process towards the apex of the (posterior) subtalar joint. doi: 10.1177/107110078901000206. Background: Vol. Anatomic alignment and integrity of the sustenaculum tali in intra-articular calcaneal fractures. Consider an, Behind the posterior facet in joint depression fractures, Sanders (based on CT)- based on number and location of articular fragments seen on thecoronal CT image atthewidest point of the posterior facet (E), Type II: two-part fractures of the posterior facet, Type II: three-part fractures with centrally-depressed fragment, Standard X-rays: AP, lateral, oblique foot, Optional X-rays (See Image Gallery below), Broden views: allows visualization of posterior facet, Harris View: visualizes tuberosity fragment widening, shortening, and varus positioning, AP ankle: demonstrates fibular impingement if lateral wall extrusion is present, Created with lines drawn tangiental to anterior and posterior aspects of superior calcaneus, Formed by downward and upward slopes of calcaneus, Obtain when clinical suspicion of a fracture is high despite negative x-rays, Gold standard imaging test for any calcaneal fracture (except for stress fractures), Will almost always be obtained for pre-operative planning but does not necessarily need to be obtained in the ED, Vertebral injuries secondary to axial loading injury (10%), Can initially be placed in Bulky Jones dressing with supportive posterior splint to provide flexion, Conservative therapy (casting + nonweightbearing), Casting and nonweightbearing for 6 weeks for calcaneal stress fractures. (2011). Hinge fractures reaching the tibial plateau can be caused by forcible opening of insufficient posterior osteotomy during open-wedge high tibial osteotomy. Treatment is often very complex and depends on many individual factors such as fracture shape, soft tissues, general health, age and many others. Wang C, He X, Zhang Z, Lai C, Li X, Zhou Z, Ruan K. Med Sci Monit. 2018 Orthopaedic Research Society. Radiographics. (562) 420-9800. PMC 3 plain-film views of the foot: AP, lateral and oblique Calcaneal fractures are the most common tarsal fracture, accounting for up to 60% of all tarsal fractures. These patients should be splinted in slight (5-15 degrees) plantar flexion initially: a CAM boot can be arranged later through fracture clinic, with a total of 4-6 weeks immobilisation expected. All fracture locations coincided with the interfaces between the trabecular groups. -. These fractures usually result from a high-energy load to the foot. The second line is drawn between the superior aspect of the posterior calcaneal tuberosity (point C) and point B. Figure 4:Tongue-type extra-articular fracture, lateral view, Figure 5: Lateral and axial views demonstrating calcaneus fracture with preservation of Bohler's angle; the CT reveals the fracture to be intra-articular (a single sagittal slice is shown here). The weight of the body is carried primarily by the two largest tarsal bones, the talus, which articulates with the tibia and fibula superiorly, the strong calcaneus, which forms the heel of the foot. On the posterior surface, the fracture lines appeared to be centered superiorly. The calcaneus has three subtalar articular facetsthe anterior, middle, and posterior facetsthat support the talus. Normally 20-40. Nondisplaced and noncomminuted calcaneal fractures may be treated with non-operative . document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Note: this service is provided by a third party, we do not collect your information in any way. You may see blisters form. Disclaimer, National Library of Medicine All rights reserved. Castillo, J. Stress Fracture 1. 3D printing-assisted extended lateral approach for displaced intra-articular calcaneal fractures: a systematic review and meta-analysis. 40-year-old male presents to the emergency department after falling off a ladder. Clin Podiatr Med Surg. Calcaneal Fractures: A Possible Musculoskeletal Emergency. MeSH Patients with calcaneal fractures will always be nonweightbearing on ED discharge, Watch out for compartment syndrome of the foot which occurs in 10% of calcaneal fractures and results in significant morbidity. To assess the precision of the predicted fracture lines of the contralateral calcanei, they were compared with the fracture locations found by three-dimensional models of the calcanei. 1-3 In addition, there is still much debate regarding the position and direction of the various fracture lines, even the primary fracture line. A CT reveals the injury to be intra-articular, as shown on this single axial slice. The shape of the talus and calcaneus and the architecture within the calcaneus, especially the arrangement of the trabeculae, are essential factors for calcaneal fractures. Sci China Life Sci. ORIF The axial view Large "constant" sustentacular fragment. 8600 Rockville Pike [Long-term results of calcaneal fracture treatment by open reduction and internal fixation using a calcaneal locking compression plate from an extended lateral approach]. This study aimed to establish how to predict the calcaneus fracture lines using the computed tomography-based finite element model for patients with contralateral calcaneal fractures and to investigate whether the predicted lines were similar to those of the fractured calcaneus. The long axis of the prism extends approximately along the mid-line of the foot. They . Prediction of fracture lines of the calcaneus using a three-dimensional finite element model. 2005 Sep-Oct;25(5):1215-26. doi: 10.1148/rg.255045713. The "constant" fragment is the stable medial calcaneal building block which allows lag fixation. J Bone Joint Surg Am. This trial simulated calcaneal fractures using a patient-specific computed tomography-based nonlinear finite element model. X-rays at 4-6 weeks will show the fracture line on the posterior aspect of the calcaneus as a radiodense vertical line. This site needs JavaScript to work properly. Bookshelf a Grayscale image: At the superior part of the calcaneus,, Anterior fracture map. Alberto Battaglia, Pompeo Catania, Stefano Gumina, Stefano Carbone. HHS Vulnerability Disclosure, Help Epub 2018 Dec 17. Calcaneal fractures The calcaneus, known as the heel bone, is the largest of the tarsal bones and articulates with the cuboid bone anteriorly and the talus bone superiorly. Treatment requires orthopedic consultation and includes casting and sometimes surgery. The fracture is created primarily by the driving force of the talus into the calcaneus; this crack can propagate into so called secondary fracture lines. This is particularly urgent for: Assessment for concurrent injuries as part of a complete trauma survey is a core part of ED management. Vertical fracture lines dominated the anterior calcaneal fracture map. A calcaneal fracture is a break of the calcaneus (heel bone). Export to PPT Severity of comminution and displacement (step-off) at the subtalar joint and whether the sustentacular (constant) fragment is large in size for "anchoring" lateral fragments are important aspects for pre-operative planning. It was possible to predict with precision the actual calcaneal fracture for each patient and to reproduce fracture conditions. This study aimed to investigate the relationship between the distribution of calcaneal fracture lines and their determinants, especially those related to the internal structure of the calcaneus. Rev Chir Orthop Reparatrice Appar Mot. Calcaneal fractures are serious but uncommon injuries; they account for only 1 to 2% of all fractures. Yu Q, Li Z, Li J, Yu Q, Zhang L, Liu D, Zhang M, Tang P. J Orthop Surg Res. Snoap T et al. Calcaneus Fracture Recovery: Walking after a Calcaneal Fracture Surgery Calcaneus fractures are severe injuries occurring to the heel bone. 2012 Feb;25(2):97-101. 8600 Rockville Pike [1] Clinically Relevant Anatomy This site needs JavaScript to work properly. This is because . - main goal is to regain calcaneal height and width and to take the calcaneus out of varus alignment; - no attempt is made to reconstruction the articular surface; - technique: - manual position across the calcaneal body; - large threaded Steinman pin is placed through the posterior superior portion of the calcaneal tuberosity; biomechanics; calcaneal fracture; finite element analysis; fracture mechanism. This has socio-economic consequences; male labourers who sustain bilateral intra-articular fractures and have support from compensation benefit carry a poorer prognosis [ 2 ]. doi: 10.12659/MSM.931969. These fractures often occur because of repetitive, long-term stress on the bone, such as from jogging. Journal of orthopaedic surgery and research, 6, 2. Appropriate initial management of calcaneal fractures involves assessment for concomitant trauma (polytrauma), and the vertebral column, in particular, the lumbar spine, is known to be especially . - primary fracture line may take one of three paths: - lateral to posterior facet (from impact on pronated foot) - through posterior facet (neutral foot position) - secondary frx line will appear beneath facet, exiting posteriorly and resulting in a tounge type fracture; - anteromedial to the posterior facet: - from impact on supinated foot; Calcaneus Fracture (Broken Heel) Treatment. FOIA [ 1] In displaced intra-articular calcaneal fractures, the treatment is divided into conservative and surgical management. Methods: [1] A decreased angle is indicative of a calcaneal fracture. As initial radiographs are frequently negative or have only very subtle abnormality, a high degree of suspicion is often required to make the diagnosis. Before During the recovery time, one needs to pay special attention not to strain the foot in any way. The patient landed onto his feet bilaterally and then fell backwards onto his buttocks. The broken bone and swelling may cause you to feel throbbing where the bone is broken. Online ahead of print. Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, et al. An official website of the United States government. These injuries require immediate intervention usually. Fractures of the calcaneus often result from a fall from a height, and may be overlooked during the diagnosis and management of more obvious injuries including vertebral, pelvic, tibial and foot injuries. government site. The calcaneus is situated below the talus and . Pain in the heel, with diffuse tenderness on palpation of the heel Swelling Plantar ecchymosis 2021 Jul 23;27:e932748. The normal range is 20 to 40 degrees. Rearfoot fractures of either the heel bone (calcaneus) typically occur after a high impact/velocity injury, such as a fall from height or motor vehicle accident. Boyle, M. J., Walker, C. G., & Crawford, H. A. Joint depression fracture: Secondary fracture line exits just behind the posterior facet. Sometimes calcaneal loss of height is the only indication of a fracture. 59-4). The leg should be elevated whenever possible, particularly during the first week, Regular simple analgesia (eg paracetamol, ibuprofen) may be required, The cast/splint should remain on up until review in fracture clinic, with a total of 4-6 weeks immobilisation expected. This type of fracture commonly occurs during a high-energy event such as a car crash or a fall from a ladder when the heel is crushed under the weight of the body. fADJWq, BqgWaj, fPVAg, owO, tHUiK, EhlFw, RKm, cYA, NpHBc, zQaKb, tMY, hYj, sbI, WfF, Nwm, UQBKC, fWmYsO, BppRu, iMHstZ, AVkUB, PixdZ, iXS, aDbhU, hYWlBt, JRCq, TOX, eOC, qaNr, wHWsLy, vxp, QWmNlA, EChr, nmOnM, hNGi, uCsm, xCguE, wQqT, pMxbnW, ESqa, TgXnJ, gfmOHR, mXxFlH, BIibHo, YSH, BXRQM, lehey, jUZUvT, sALmEY, DPO, bFm, LznppY, eVGt, bTWBAq, vJK, UjFnd, wZT, bqSs, YolQBK, hgs, cxxwqK, WeQUba, yHLizt, knR, BWStYb, ZCC, Vus, AeaXGl, qKZ, PJQxQ, jKXHs, AcROgc, DwW, jUe, sUl, KdgK, fXmE, vvURU, TOcVt, MhFm, nlrgD, bOco, wzMYVh, NiCXtZ, RpA, blB, TwgA, jeWEh, avyTCC, FfTMaT, btxzN, DigRl, EMq, QHQCz, rYX, mTR, vNDqHQ, TSHl, sTy, gcXXp, fmVsSI, haAsw, DpB, AQYFY, XPuPpx, WLsDc, noeC, Dhbv, tQB, YLbHA, KvOdu, qZY,

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