2. Introduction
2 % of all fractures…….of these: Displaced intra articular comprising of 60 to 75
% of these injuries
10 % asso with spine injuries
26 % with other extremity injuries.
Compartment syndrome
Age group 21 to 45 years…usually in men as
they are more into construction and industrial
work.
8. Mechanism of injury (Essex Laprosti)
Usually
caused by axial load
mechanism. Can be fall from height,
motor vehicle accident…….making it
reason to check for other axial load
injuries such as lumbar , pelvic and tibial
plateau fractures.
9. How this axial load mechanism
works
Contact point with calcaneum…(that is with above lying bone
tallus )…is situated lateral to weight bearing axis of lower extremity.
Now as this axial load force is applied via tallus over the posterior
facet of calcaneum….as shearing force…..which gets directed
from posterior facet to medial wall of calcaneus.
All this will result in…………………………………………………………..
10. Primary Fracture line
Almost always present ….extending from proximal medial aspect of
calcaneal tuberosity, through anterolateral wall.
11. Now this fracture can be
positioned on posterior facet
Over medial
third..nearsustentaculum tali,
The central third
Or lateral third near lateral
wall
12. Continuing with AXIAL FORCE OVER
CALCANEUM
NOW
as the axial force continues medial spike or
fragment attaced to sustentaculum tali pushed further
toward the medial aspect of heel.
Various further secondary fracture lines occur in the
region of posterior facet……
13. Essex Lopresti classification based on xray
If
fracture line producing
posterior facet fragment exits
behind the posterior facet and
anterior to Achilles tendon
attachment…it is JOINT
DEPRESSION TYPE
If
it is exiting distal to Achilles
tendon insertion …it is TONGUE
TYPE.
16. Lateral view
to aces height loss…..which is asssed by ‘bohler angle’
Bohler angle is angle between line
drawn from highest point of anterior
process of calcaneus to the highest
point on posterior facet….and a line
drawn tangentially from posterior
facet highest point to tuberosity
superior edge….normally angle is 20
to 40.
Decrease in angle indicate weight
bearing posterior facet has collapsed
.
17. Gissane’s angle
Two
strong cortical struts ….one
extending along lateral margin of
posterior facet and other
extending anterior to beak of
calcaneum,,
Comes
directly below lateral
process of tallus
Form
obtuse angle …that is more
than 90…..
18. Ap
and olblique views to acess anterior process and
clcaneo cuboid involvement…
Brodens view – wich will demonstrate posterior
facet.
19. Classification based on ct scan.
Sanders classification…
Based on ct images in coronal plane.Calcaneum is
Divided into 3 potential fragments- Medial, central
And lateral….4 th potential fragment Is added up
By adding sustentaculum.
20. Type 1
All
non displaced articular
fragments . Regardless of
number of fracture lines are
considered
21. Type 2
Two
part fracture of posterior facet. 2a , 2b and 2 c
existed on basis of location of primary fracture line.
22. Type 3
Three part fractures that usually featured centrally depressed
fragment.
Again as in type 2…..based on fracture line…it includes 3AB,
3 AC and 3 BC.
23. Type 4
4 Part articular fractures, highly comminuted and
often have more than 4 articular fragments