rowe calcaneal fracture classification

Foot Ankle Clin. - main goal is to regain calcaneal height and width and to take the calcaneus out of varus alignment; The authors concluded that MIS can achieve acceptable fracture reduction and that it can serve as the primary definitive treatment option for open fractures of the calcaneus. Towson, MD 21204 2002 Oct. 84 (10):1733-44. Radiographics. [QxMD MEDLINE Link]. Juliano P, Nguyen HV. As you move from type 1 to type 4 injuries, expected outcomes are progressively worse. Zwipp H, Paa L, ilka L, Amlang M, Rammelt S, Pompach M. Introduction of a New Locking Nail for Treatment of Intraarticular Calcaneal Fractures. J Bone Joint Surg Br. Diabetes Sports Medicine 28 (2):7352. - Calcaneal Frx in Children Calcaneus Fractures Workup - Medscape The calcaneal composition has a significant influence on preoperative planning. 1) Parrot nose type This site needs JavaScript to work properly. [QxMD MEDLINE Link]. Foot Ankle Int. Norris correctly described a compression mechanism in calcaneus fractures in 1839, and in 1843, Malgaigne describedtwo types of calcaneal fractures; this description formed the first rudimentary classification system. [QxMD MEDLINE Link]. [QxMD MEDLINE Link]. Practitioner. Microbiology and Infection Control The resultant primary fracture line extends from the lateral aspect of the angle of Gissane in a posteromedial direction, initiating an oblique, primary fracture line. Biomechanics - most crucial measurement is degree of continuity of posterior facet, which is best determined by CT scan; [25] Assessment involved a combination of radiography with Short Form (SF)-36 and AOFAS questionnaires. [CDATA[ Bridgman SA, Dunn KM, McBride DJ, Richards PJ. Calcaneal Fracture : Wheeless' Textbook of Orthopaedics - longitudinal traction is applied across the Steinman pin w/ a valgus vector applied as well; - smoking patient who is unwilling to immediately quit smoking; Please confirm that you would like to log out of Medscape. The body of the calcaneus is composed primarily of cancellous bone, having a comparatively thin cortex. 2020 Jul 28;5(3):2473011420927334. doi: 10.1177/2473011420927334. [QxMD MEDLINE Link]. Results After Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures. The os calcis is the most frequently fractured tarsal bone, accounting for more than 60% of tarsal fractures. Crosby LA, Fitzgibbons T. Intraarticular calcaneal fractures. - talus become dorsiflexed; - fracture classification: Note loss of Bhler angle. - further axial loading may fracture tuberosity fragment creating a supero-lateral fragment of posterior facet; - heel becomes shortened and widened; Am J Orthop Surg. 2008 Apr;22(4):459-62. - soft tissue injury: At the time the article was last revised Yuranga Weerakkody had no recorded disclosures. Unauthorized use of these marks is strictly prohibited. Bilateral calcaneus fractures sustained in motor vehicle collision. Foot and Ankle Disorders. The bone distractor apaprently retracted the soft-tissue flap, helped reduce the articular and tuberosity fragment, and improved visualization by distracting the posterior talocalcaneal joint. Foot Ankle Int. Lakstein D, Bermant A, Shoihetman E, Hendel D, Feldbrin Z. If compartment syndrome is not recognised early clawing of toes, stiffness, aching, sensory changes Extra-articular fractures, with some exceptions, are generally treated in a closed manner. - tuberosity fragment (posterolateral fragment) [20]. Clin Orthop Relat Res. Zhang W, Lin F, Chen E, Xue D, Pan Z. Operative Versus Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures: A Meta-Analysis of Randomized Controlled Trials. Clin Orthop Relat Res. Despite 145 years of different treatment techniques, no consensus has been reached. Cao Y, Xu X, Guo Y, Cui Z, Zhao Y, Gao S, et al. Rowe classification Flashcards | Quizlet - early mobilization with protection from wt bearing is maintained until frx union occurs; Calcaneus fractures are rarely encountered as open fractures. 1) avulsion due to pull of bifurcate ligament or EDB muscle, supination 2) compressive, pronated Rowe 2a Beak fracture, land on heel with knee extended and foot dorsiflexedRowe 2b avulsion of the entire insertion of the Achilles, older patients with DM and osteoporosis Rowe 3a simple body fracture, STJ not fractured or depressed Rowe 3b comminuted body fracture, STJ not fractured or depressedIf the posterior facet is not involved, usually closed reduction with cast immobilization for six weeks is good.Rowe 4a simple body fracture, STJ fracture, but not depressedRowe 4b comminuted body fracture, STJ fracture, but not depressedRowe 5a comminuted body fracture, STJ fracture, and STJ depressionRowe 5b comminuted body fracture, STJ fracture, STJ depression, CC joint fracture Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus. - fracture classification: - Sander's Classification: - Rowe: types 1-5 (types 4-5 intra-articular) - Essex Lopresti: - extra-articular - intra-articular - tongue fracture - joint depression calcaneal fracture - associated injuries: - frx of contra-lateral foot; - spinal compression frx; - soft tissue injury: The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Wilkinson BG, Marsh JL. Calcaneal fracture classification: a comparative study. Calcaneus fractures - Stefan Rammelt, Hans Zwipp, 2006 - SAGE Journals Intra-Articular Fractures of the Calcaneus. James K DeOrio, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Association of Graduates, United States Air Force Academy, Doctors Mayo Society, Mayo Clinic Alumni Association, Society of Air Force Clinical Surgeons, Society of Military Orthopaedic SurgeonsDisclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Exactech; Treace Medical; Additive; Mirus; Crossroads Orthopedics
Serve(d) as a speaker or a member of a speakers bureau for: Exactech; Treace Medical; Additive; Mirus; WoultersKluwer; Crossroads Orthopedics
Received income in an amount equal to or greater than $250 from: Exactech; Treace Medical; Additive; Mirus; WoultersKluwer; Crossroads Orthopedics. var m3_r = Math.floor(Math.random()*99999999999); Ten percent of calcaneus fractures are bilateral. Wheeless' Textbook of Orthopaedics. Calcaneus fractures. 1958 Apr. - all frx are initially treated by strict bed rest, elevation, until acute swelling has subsided; [QxMD MEDLINE Link]. Skeletal Trauma. Intra-articular fractures of the calcaneus. Calcaneal fractures are relatively uncommon, comprising 1 to 2 percent of all fractures, but important because they can lead to long-term disability. 2007;36(1):1-10. You are being redirected to Type 1C Anterior process fracture document.write ("?zoneid=188"); Rare injury caused by forced inversion of the foot. - distraction helps restore calcaneal width and height Wechsler R, Schweitzer M, Karasick D, Deely D, Morrison W. Helical CT of Calcaneal Fractures: Technique and Imaging Features. 4) Horizontal The medical approach for calcaneal fractures. Bethesda, MD 20894, Web Policies A frustrating factor that perpetuates this disagreement is the subset of calcaneus fractures with poor long-term outcomes, regardless of management. Rowe Classification: Types I-III do not involve the subtalar joint. The https:// ensures that you are connecting to the 4. Li S. Wound and Sural Nerve Complications of the Sinus Tarsi Approach for Calcaneus Fractures. 6. Mansoor AhmedBohlers angle 1) most superior aspect of the posterior facet (posterior articular surface) to the highest point of the anterior process 2) superior portion of the calcaneal tuberosity to most superior aspect of posterior facetGissanes angle 1) along the lateral border of the posterior facet 2) along the anterior process of the calcaneus. Extensive intraarticular fractures of the foot. Fracture characterization is essential to guide the management of these injuries. Limited Approaches to Calcaneal Fractures. - primary frx line: - most of these involve the posterior facet (but can involve anterior and middle facets); Comparing different types of calcaneal fractures, associated treatment options, and outcome data is currently hampered by the lack of consensus regarding fracture classification. Robert A Probe, MD is a member of the following medical societies: American Medical Association, Texas Medical Association, AO Foundation, American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma AssociationDisclosure: Received consulting fee from Stryker Orthopaedics for consulting. The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2and ~60% of all tarsal fractures 3. [QxMD MEDLINE Link]. Results of closed treatment, Operative Versus Nonoperative Treatment of Displaced Intra-Articular Calcaneal Fractures, Age, Gender, Work Capability, and Worker's Compensation in Patients with Displaced Intraarticular Calcaneal Fractures, Primary Subtalar Fusion for Calcaneal Fracture, Treatment of Displaced Intra-Articular Calcaneal Fractures with Closed Reduction and Percutaneous Screw Fixation, Intra-Articular Fractures of the Calcaneus. 110 West Rd., Suite 227 [QxMD MEDLINE Link]. - anteromedial (sustentacular) frag is rarely comminuted but varies in size; Epub 2020 Oct 27. BMC Surg. 14:290. 2022. Eckstein et al reported long-term (20 y) follow-up of 22 patients who underwent surgical treatment of displaced calcaneal fractures. 2016 Mar. The Sanders classification system is used to assess intraarticular calcaneal fractures, which are those involving the posterior facet of the calcaneus. Twelve observers classified 30 intra-articular calcaneal fractures . 60-75% of injuries are intra-articular fractures, no significant increase in infection rates, peak incidence in women in seventh decade of life, violent contaction of the triceps surae with forced dorsiflexion, strong concentric contaction of the triceps surae with knee in full extension, intrinsic tightness of the gastrocnemius and achilles tendon, peripheral neuropathy leading to decreased pain sensation and proprioception resulting in recurrent microtrauma, increased physical activity in the setting of relative energy deficiency, primary fracture line results from oblique shear and leads to the following, includes the sustentaculum tali and is stabilized by strong ligamentous and capsular attachments, dictate whether there is joint depression or tongue-type fracture, strong contraction of gastrocnemius-soleus with concomitant avulsion at its insertion site on calcaneus, more common in osteopenic/osteoporotic bone, inversion and plantar flexion of the foot cause avulsion of the bifurcate ligament, superolateral fragment contains the articular facets, superior articular surface contains three facets that articulate with the talus, the flexor hallucis longus tendon is medial to the posterior facet and inferior to the medial facet and can be injured with errant drills/screws that are too long, between the middle and posterior facets lies the, projects medially and supports the neck of talus, connects the dorsal aspect of the anterior process to the cuboid and navicular, calcaneal tuberosity (Achilles tendon avulsion), the primary fracture line runs obliquely through the posterior facet forming two fragments, the secondary fracture line runs in one of two planes, the axial plane beneath the facet exiting posteriorly in, when the superolateral fragment and posterior facet remain attached to the tuberosity posteriorly, behind the posterior facet in joint depression fractures, based on the number of articular fragments seen on the coronal CT image at the widest point of the posterior facet, One fracture line in the posterior facet (, Two fracture lines in the posterior facet (, based on fracture morphology of the calcaneus tuberosity, tenting, ecchymosis, or lack of skin blanching with tuberosity fractures, neccessitates urgent sugical reduction and fixation to avoid posterior heel skin necrosis, must be debrided and epithelialized prior to surgical intervention, lack of heel cord continuity in avulsion fractures, lack of posterior heel skin blanching with tenting fractures, assess for compartment syndrome secondary to swelling, presence of Langer's lines and skin wrinkles suggests skin is appropriate for surgical intervention, decreased ankle plantarflexion strength with avulsion fractures, assess for neuologic compromise due to swelling, severe peripheral vascular disease may preclude surgical treatment due to poor wound healing potential, useful for evaluation of intraoperative reduction of posterior facet, with ankle in neutral dorsiflexion and ~45 degrees internal rotation, take x-rays at 40, 30, 20, and 10 degrees cephalad from neutral, visualizes tuberosity fragment widening, shortening, and varus positioning, place the foot in maximal dorsiflexion and angle the x-ray beam 45 degrees, demonstrates lateral wall extrusion causing fibular impingement, indicates partial separation of facet from sustentaculum, angle between line from highest point of anterior process to highest point of posterior facet + line tangential to superior edge of tuberosity, represents collapse of the posterior facet, angle between line along lateral margin of posterior facet + line anterior to beak of calcaneus, demonstrates posterior and middle facet displacement, demonstrates calcaneocuboid joint involvement, used only to diagnose calcaneal stress fractures in the presence of normal radiographs and/or uncertain diagnosis, cast immobilization with nonweightbearing for 10 to 12 weeks, anterior process fracture involving <25% of calcaneocuboid joint, comorbidities that preclude good surgical outcome (smoker, diabetes, PVD), avoids the high wound complications seen with these fractures, minimally displaced tuberosity fractures (<1 cm of displacement) without threatened soft-tissue envelope in elderly patients with reduced function or physical capacity, begin early range of motion exercises once swelling allows, early reduction prevents skin sloughing and need for subsequent flap coverage, ideal in patients with sever peripheral vascular disease or severe soft-tissue compromise, lag screws from posterior superior tuberosity directed inferior and distal, require urgent reduction and fixation to avoid skin necrosis (disastrous consequence), open reduction allows for sufficient debridement of contaminated tissue, inability to participate in closed treatment, large extra-articular > 2 mm displacement, posterior facet displacement >2 to 3 mm, flattening of Bohler angle, or varus malalignment of the tuberosity, anterior process fracture with >25% involvement of calcaneocuboid joint, wait 10-14 days until swelling and blisters resolve and wrinkle sign present 10-14 days, no benefit to early surgery due to significant soft tissue swelling, displaced tuberosity fractures with posterior skin compromise should be addressed urgently, number of intra-articular fragments and the, surgical treatment decreases the risk of post-traumatic arthritis, age > 50 (similar outcomes with surgical and nonsurgical treatment), initial Bhler's angle <0 (these injuries do poorly regardless of treatment), lower Bhler angles suggest greater energy absorbed, open fractures (significant soft tissue injury and engery absorbed), bilateral calcaneal fractures (significant gait problems following bilateral injuries), factors associated with most likely need for a secondary subtalar fusion, male worker's compensation patient who participates in heavy labor work with an initial Bhler angle less than 0 degrees, standard short-leg cast for calcaneal stress fractures, standard short-leg cast applied with mild equinus, windowed over posterior heel to allow for frequent skin checks, requires close follow-up to determine if pull of gastrocnemius-soleus dispaces fracture, weekly cast changes are necessary due to high incidence of skin complications, high incidence of vascular insufficiency and diabetes in this population, ideal for poor soft tissue coverage or patients with peripheral vascular disease, Steinmann pin placed into the fracture site anteromedially-to-posterolateral to leverage fragments into place, additional K-wires and Steinmann pins are placed from posterior-to-anterior and lateral-to-medial to secure remaining bone fragments, calcaneal transfixin pin can be used to distract fracture, percutaneus tamps and elevators can be used to raise the articular surface, pins are cut flush with the skin and removed 8-10 weeks post-op, can be combined with distracting external fixator, pins placed in calcaneal tuberosity, cuboid, and distal tibia, restor calcaneal height, width, and alignment, can be combined with percutaneous cannulated screws, extensile lateral L-shaped incision is most popular, vertical portion inbetween posterio fibula and achilles tendon, horizontal portion in line with 5th metatarsal base, a more inferior incision protects the sural nerve, provides access to the calcaneocuboid and subtalar joints, full-thickness skin, soft tissue, and periosteal flaps are developed, lateral calcaneal branch of peroneal artery, superior flap contains the calcaneofibular ligaments and peroneal tendon sheath, sural nerve and peroneal tendons are retracted superiorly, fracture opened and medial wall reduced going medial to lateral, reduction confirmed indirectly via fluoroscopy, tuberosity reduction is done under direct visualization, manual traction, Schanz pins, and minidistractors, height and length of tuberosity is recreated, definitive fixation with plates and screws, restore Bhler's angle and calcaneal height, minimally invasive incision that minimizes soft tissue dissesction, reduces wound complications associated with extensile lateral incision, allows direct visualization of the posterior facet, anterolateral fragment, and lateral wall, same incision can be utilized for secondary subtalar arthrodesis or peroneal tendon debridement, patient placed in lateral decubitus position, incision made in line with the tip of the fibula and the base of the 4th metatarsal, extensor digitorum brevis retracted cephalad to expose sinus tarsi and posterior facet, Schanz pin inserted percutaneously in posteroinferior tuberosity going from lateral to medial, provides distraction and aids with reduction, fibrous debris and fat removed from sinus tarsi, small elevator or lamina spreader placed under posterior facet fragment to aid in reduction, K-wires inserted for provisional fixation aimed towards the sustentaculum, two screw are placed lateral-to-medial to engage sustentaculum and support facet, one large fully threaded screw from posterior-to-anterior to support axial length of calcaneus, low-profile plate is applied underneath a well developed soft tissue envelope with screws engaging anterolateral and tuberosity fragments, nonweight bearing for 6-8 weeks post-op with ankle range-of-motion exercises beginning 2 weeks post-op, manipulate the heel to increase the calcaneal varus deformity, manipulate the heel to correct the varus deformity with a valgus reduction, stabilize the reduction with percutaneous K-wires or open fixation as described above, arthroscopic-assisted reduction and internal fixation, improved visualization of articular surface and carilage lesions, increased swelling from fluid extravasation, can be combined with sinus tarsi approach, patient positioned in lateral decubitus position, fluoroscopy unit positioned posterior and oblique to patient, anterolateral and posterolateral portals are used to visualize posterior facet, loose bodies and cartilage fragments are removed with a shaver, Freer elevator is introduced into one of the portal sites and used to elevate the posterior facet, Schanz pin to control tuberosity fragment, cannulated screws from the posterior aspect of the calcaneal tuberosity to the anterior aspect of the calcaneus, lateral-to-medial screws placed in sustentaculum, buttress screw from the posterior aspect of the calcaneal tuberosity to the subchondral bone of the posterior facet, posterior approach for calcaneal tuberosity fractures, fracture fragment is mobilized and debrided, plantar flexion of foot aids with reduction, presence of gastrocnemius tightness may preclude reduction, Strayer procedure may be performed to aid in reduction, figure-of-8 tension-band wire passed around ends of K-wires or cannulated screws, Krackow sutures passing through bone tunnels, restricted weight bearing for 6 weeks followed by progression of weight bearing an additional 6 weeks, performed in highly comminuted Sanders IV intraarticular fractures, high rate of secondary fusion after ORIF with these injuries, avoids added treatment costs and decreases time off from work, can be performed through an extensile lateral or sinus tarsi approach, fracture reduction is perfromed in a similar fashion as ORIF, articular cartilage of the subtalar joint denuded to bleeding subchondral bone, cannulated compression screws are placed from the posterio calcaneal tuberosity to the talar dome, lateral fixation plate applied to hold reduction, increased risk in smokers, diabetics, and open injuries, may consider nonoperative treatment in these patients, tongue type fractures at high risk (>20%) for posterior skin necrosis, should be splinted in 30 degrees of planarflexion to relieve soft tissue tension, keep all hardware away from the corner of the incision, delayed wound healing is the most common complication, can be addressed with ankle bracing (gauntlet type), NSAIDs, injections, and physical therapy, may require bone block subtalar arthrodesis to address loss of calcaneal height, important when there are symptoms of anterior ankle impingement, Lateral impingement with peroneal irritation, at risk with placement of lateral to medial screws, especially at level of sustentaculum tali (constant fragment), loss of height, widening, and lateral impingement, distraction bone block subtalar arthrodesis, incongruous subtalar joint/post-traumatic DJD, results from posterior talar collapse into the posterior calcaneus, Lateral exostosis with no subtalar arthritis, Lateral exostosis with subtalar arthritis, Lateral exostosis, subtalar arthritis, and varus malunion, increased due to mechanism (fall from height), smoking, and early surgery, lateral soft tissue trauma increases the rate of complication, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries.

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