My Orthopaedic Surgeon

Paul Tornetta III, MD: We know decision making with respect to calcaneal fracture management can be difficult. Can classification help? Classification is only valuable if it is prognostic and if it assists decision making. Otherwise, it is useless.

Richard E. Buckley, MD. Excellent presentation on methods of treatment of calcaneal fractures. For educational purposes may be copied, adapted and presented with acknowledgements to Dr Buckley and OTA

Bruce J. Sangeorzan, MD, is associate professor of orthopaedic surgery, University of Washington, Harborview Medical Center. The literature is full of suggestions for the treatment of calcaneus fractures. Yet it is possible to read hundreds of papers devoted to calcaneus fractures and still not know which to treat or how to treat them. Closed treatment with early motion is a moderately successful treatment that remains the standard to which new treatments must be compared. However, failure to seek alternatives to closed treatment would have us accept impairments beyond a standard that would be acceptable in other intra-articular weight-bearing joints. As in most orthopaedic conditions, no valid prospective randomized trial has been completed. In the absence of such a trial, we base treatment decisions on training, experience, retrospective studies and, most worrisome, the vagaries of third-party dictum.

Wheeless' Textbook of Orthopaedics
Discussion:
- typically results from fall from height (see mechanism)
- 2 types of frx may occur: extr-articular and intra-articular:

Talus Fractures
Keith Mayo
OTA Basic Fracture Course

Reports from Medscape Orthopaedics and Sports Medicine 1999
Ipsilateral femoral neck and shaft fractures
Fracture Healing in Tibia Fractures With an Associated Vascular Injury
The Treatment of Lisfranc Injuries
Open Fractures of the Patella: Long-term Functional Outcome

Discussion:
- injuries to cuboid may be accompanied by impaction with loss of bone stock;
Associated Injuries:
- navicular tuberosity fracture:
- Lisfranc fracture:
- midfoot/forefoot fractures:
- midtarsal injuries:
Wheeless' Textbook of Orthopaedics

Menu includes -
- Anterior Talar Impingement Syndrome
- Avascular Necrosis and Salvage of Talus Fractures
- Blood Supply to Talus
- Congenital Vertical Talus
- Talar Head Fracture:
- Fractures of the Talar Neck:
- Lateral Talar Process Frx:
- Posterior Process Talus Frx:
- Osteochondral Lesions of the Talus
- Radiographic Evaluation:
- Sub Talar Dislocation
Wheeless' Textbook of Orthopaedics

- involves fracture at base of fifth metatarsal at metaphyseal-diaphyseal junction, which typically extends into the 4-5 intermetatarsal facet;
- Jones fracture is located w/in 1.5 cm distal to tuberosity of 5th metatarsal & should not be confused w/ more common avulsion fracture of 5th metatarsal styloid;
Wheeless' Textbook of Orthopaedics

- two processes, lateral & posterior, project from body of talus;
- either process may be fractured, either as isolated injury or associated with other ankle or talar injuries;
- it is frequently confused with an ankle sprain;
- non union is a frequent complication of displaced lateral process fracture;
Wheeless' Textbook of Orthopaedics

mechanism:
- because 2nd metatarsal is the longest metatarsal proximally, it will often be fractured at its base, with the other metatarsals dislocated;
- dorsal capsule of Lisfranc's joint, lacking sufficient reinforcement, will fail to support the load and will collapse, resulting in dorsal fracture dislocation of the metatarsal bases;
Wheeless' Textbook of Orthopaedics

Fifth metatarsal fracture patterns
Anatomy of the midfoot
Wheeless' Textbook of Orthopaedics

- two processes, lateral & posterior, project from body of talus
- either process may be fractured, either as isolated injury or associated with other ankle or talar injuries;
Wheeless' Textbook of Orthopaedics

A simple method for pedicle protection in flap surgery for posterior heel defects. Indian Journal of Plastic Surgery 36(2)2003

Navicular joins in front with medial, intermediate, & lateral cuneiform bones, which articulate anteriorly with first, second, and third metatarsals;
- navicular provides insertion for tibialis posterior;
- blood supply to the navicular bone is radial and extraarticular & is subject to loss both at time of injury & at time of surgical treatment;
Wheeless' Textbook of Orthopaedics