Calcaneus Extra-articular

Pre and Postop of Extra-articular Calcaneus fracture

Pre and Postop Minimally Invasive Percutaneous Fixation Displaced Extra-Articular Calcaneus Fracture in RA patient

 

X-ray of avulsion fracture of the calcaneus where the Achilles pulls off a fragment of the heel bone (below left). Another example of an extra-articular fracture of the calaneus is the tongue type fracture show in an adolescent (bottom right).

If secondary fracture line travels parallel with the plantar aspect of the foot, exiting at the posterior border of the calcaneus, a tongue fracture will develop.

  • Secondary fracture line extends posteriorly from superior part of primary fracture line (at crucial angle), creating 1 single posterior, superior, & lateral fragment.
  • Hence, the coronal fracture occurs posterior to the tuberosity.

Includes:

  • Sustenacular fragment: - contains medial aspect of posterior articlar fragment.
  • Tongue fragment: contains tuberosity & lateral aspect of posterior articular fragment.
  • Inferior portion of body of the calcaneus.
  • Fragmentation of the lateral wall is often mild.
  • Comminution anterior to the Angle of Gissane will often be severe.
  • Tongue fracture fragment will include portion of achilles tendon.
  • With displacement of tongue fragment there will be excessive tension on the posterior skin which can lead to necrosis.

Treatment:

  • ORIF fracture fragment.
  • Removal of fracture fragment and advancement of Achilles to calcaneus.

Series of Intraop Pics of an achilles rupture with part of posterior calcaneus still attached. This was a 17 year old competitive cheerleader who jumped and injured her heel.

The achilles torn off of the back of the calcaneus and a portion of the heel is still attached to the Achilles. The back of the heel bone is the rounded yellowish bone at the bottom of the incision site.

Nonabsorbable suture has been weaved through the Achilles to repair it back to the back of the calcaneus

A trough is made in the calcaneus due allow the tendon to have ingrowth at its reattachment site in the posterior heel.

The suture from the Achilles is placed through two small drill holes in the trough and out the bottom of the heel bone.

The Achilles is tensioned down into the trough and reattached to the calcaneus

Below, MRI of a nonunion of an anterior process avulsion fracture (Shown above th white arrow)