may need to be supplemented by orthotic support with a custom-molded insole, rocker-bottom shoe, or ankle-foot orthosis historical treatment has included closed reduction (Bohler) w/ distraction and medial lateral compression early mobilization with protection from wt bearing is maintained until frx union occurs nondisplaced frx w/ mild or moderate decrease in Bohler's < are initially treated by early mobilization, avoidance of wt bearing for 6 weeks all frx are initially treated by strict bed rest, elevation, until acute swelling has subsided most crucial measurement is degree of continuity of posterior facet, which is best determined by CT scan with advanced age, diabetes, or questionable vascular exam, order non invasive vascular studies smoking patient who is unwilling to immediately quit smoking Wound healing complications in closed and open calcaneal fractures. Open calcaneal fractures: results of operative treatment. Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome. Compartment syndrome of the foot after intraarticular calcaneal fracture. The management of soft-tissue problems associated with calcaneal fractures. more common with severe comminuted fractures. compartment syndrome deep central compartment is involved most often in calcaneal frx Rowe: types 1-5 (types 4-5 intra-articular) frx extends thru posterior facet which becomes incongruous displaced supero-lateral fragment can impinge upon peroneal tendons tuberosity fragment tilts into varus and is pulled proximally by the Achilles tendon anteriorly frx may exit laterally, usually at angle of Gissane, but it can also involve the calcaneocuboid joint thalamic fragment: depressed portion of the posterior facet further axial loading may fracture tuberosity fragment creating a supero-lateral fragment of posterior facet displaces superiorly & laterally resulting in incongruity of posterior facet and widening & shortening of heel tuberosity fragment (posterolateral fragment) Displacement of the Sustentacular Fragment in Intra-Articular Calcaneal Fractures it remains attached to the talus by strong deltoid ligament and by the interosseous ligament lies in the interosseous sulcus anteromedial (sustentacular) frag is rarely comminuted but varies in size sustentacular fragment (constant fragment) most of these involve the posterior facet (but can involve anterior and middle facets) 2 types of frx may occur: extra-articular and intra-articular: The most successful results were in the patients who had had a subtalar arthrodesis.- typically results from fall from height (see mechanism) There was a trend (p = 0.07) that the longer the interval between the injury and the operation, the longer the subsequent interval until the patient returned to full activities or work. Pain was partially relieved in thirty-eight (90 per cent) of the patients, function improved in thirty-five (83 per cent), and thirty-two (76 per cent) of the patients returned to work or to a pre-injury level of activity at a mean of eight months (range, four to sixteen months) after the operation. The difference between the preoperative and postoperative rating scores was used to measure any improvement in function. The patients were examined at a mean of thirty-two months (range, twenty-six to fifty-two months) after the operation. An in situ subtalar arthrodesis had been performed in fifteen patients a subtalar distraction bone-block arthrodesis, in fourteen a triple arthrodesis, in five a lateral calcaneal ostectomy, in seven a transection and proximal transposition of the sural nerve, in seven and a release of the tibial nerve, in five. The operations had been performed a mean of twenty-six months (range, six to seventy-two months) after the injury. We retrospectively reviewed the results of the operative treatment of forty-three fractures of the calcaneus in forty-two patients (thirty-six men and six women).
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