Keywords:
Trauma, Technical aspects, Diagnostic procedure, CT, Musculoskeletal joint, Musculoskeletal bone
Authors:
R. P. Dias, P. Ninitas, J. Janeiro; Lisbon/PT
DOI:
10.1594/essr2017/P-0296
Background
The calcaneus bone is the most commonly fractured tarsal bone and accounts for about 2% of all fractures and account for 60% of all tarsal fractures. Also known as “lover’s” fractures or “Don Juan” fractures,
60% of cases are associated with axial load mechanisms,
usually car accidents or with falls from a height,
with bilateral injuries in less than 10%.
Ten percent of patients with calcaneal fractures have associated spine fractures,
and 26% have other extremity injuries.
Approximately 90% of calcaneal fractures occur in young men in their working prime,
and the majority of these injuries occur in industrial workers.
Several reports have established that patients may be totally incapacitated for up to 3 years and at least partially impaired for up to 5 years after injury.
The most common symptom is pain,
especially intense when tightening the heel of the patient.
At physical examination,
findings such as tenderness,
excessive swelling,
ecchymosis,
and possible tarsal tunnel neural compromise may be found.
Soft tissue assessment is essential for the management of these fractures,
according to the commitment of ligaments and/or tendons.
Conventional radiography is commonly used for initial evaluation of calcaneal injury.
Abnormalities in Gissane and Böhler angle are classic findings in conventional radiology.
However,
multidetector CT using multiplanar reconstructions (MPR) allows better visualization and characterization of fracture lines and fragment displacement which is essential to guide the management of these injuries.
Classification systems are used to facilitate communication among surgeons,
augment preoperative planning,
and assist in outcomes analysis after treatment,
and therefore they must be sufficiently reproducible to be of use.
Classification systems based on plain radiography have long existed,
but they have been only marginally useful,
in part because of variations in imaging technique and limited accuracy in delineating fracture patterns.
The development of CT scanning has revolutionized the management of calcaneal fractures because it has allowed imaging techniques to become standardized,
leading to the development of modern classification systems.
Of these,
we illustrate here the Sanders and Regazzoni classification as they exhibit higher prognostic value and are now among the most commonly used.