Heel Bone Fracture

Описание: Calcaneus fractures — also known as heel bone fractures — are complex injuries that often result from high-energy trauma. Here's a detailed breakdown:

🦴 Anatomy of the Calcaneus
Largest tarsal bone, forms the heel
Articulates with:
Talus (superiorly) → subtalar joint
Cuboid (anteriorly)
Acts as a weight-bearing and force-distribution bone
Includes:
Posterior tuberosity (Achilles tendon attachment)
Sustentaculum tali (medial shelf for talus)
Body, anterior process, and middle facet

🧨 Mechanism of Injury
High-energy axial load is the most common cause
E.g., fall from height, motor vehicle accident
Can also occur with low-energy twisting injuries in osteoporotic patients

🧩 Types of Calcaneus Fractures
Fractures are classified as:
1. Intra-articular (≈75%)
Involve subtalar joint
Often displaced
Worse prognosis
Classified by Sanders classification (based on CT coronal views)
2. Extra-articular (≈25%)
Do not involve the subtalar joint
Includes:
Anterior process fracture
Tuberosity avulsion fracture
Sustentaculum tali fracture
Body fracture without joint involvement

📊 Sanders Classification (CT-Based)
For intra-articular fractures (posterior facet):
Type I: Non-displaced
Type II: Two-part fracture
Type III: Three-part fracture
Type IV: Comminuted (+3 fragments)
Prognosis worsens with increasing Sanders type.

🩻 Diagnosis
Clinical Exam:
Heel pain, swelling, ecchymosis
Inability to bear weight
Consider compartment syndrome (rare but serious)
Imaging:
X-ray (lateral, axial, oblique)
Look for Böhler’s angle:
Normal: 20–40°
Flattened (less than 20°) = suggests fracture
CT scan: gold standard for classification, surgical planning

🛠️ Treatment Options
Non-Operative:
Indicated for:
Non-displaced fractures
Extra-articular fractures
Low-demand patients
Method: Immobilization (boot/cast), non-weight bearing ~6–8 weeks
Operative:
Indicated for:
Displaced intra-articular fractures
Open fractures
Sanders II or III (sometimes IV)
Method: ORIF (Open Reduction Internal Fixation)
Lateral extensile approach (standard)
Newer: Sinus tarsi approach, percutaneous fixation
In severely comminuted cases (Sanders IV), subtalar fusion may be needed.

⏱️ Recovery Timeline
Weight bearing delayed for 8–12 weeks
PT starts early for range of motion
Return to work/sports: 4–6 months, depending on occupation
Full recovery may take up to 1 year

⚠️ Complications
Wound complications (especially with lateral extensile incision)
Post-traumatic arthritis
Subtalar stiffness
Malunion/malalignment (loss of heel height or varus deformity)
Chronic pain
Compartment syndrome (rare, check for tense swelling, neurovascular signs)

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