Calcaneal fracture
Introduction
Introduction to calcaneal fracture Adults of this disease occur more often, often falling from high places or crushing and causing injuries. Often accompanied by spinal fractures, pelvic fractures, head, chest, abdominal injuries, do not make mistakes at the time of initial diagnosis. The calcaneus is a cancellous bone. The blood supply is relatively abundant, and the bones are not very rare. However, if the fracture line enters the articular surface or is poorly restored, it is common to have traumatic arthritis and pain in the calcaneus. basic knowledge Proportion of disease: calcaneal fractures accounted for 2% of total body fractures, accounting for 60% of all tibial fractures, and the highest incidence of foot fractures, of which 60% to 75% of patients with calcaneal fractures were intra-articular fractures, involving The population is mainly 20 to 40 years old, accounting for about 90%. Susceptible people: good for adults Mode of infection: non-infectious Complications: swelling, vascular injury
Cause
Cause of calcaneal fracture
(1) Causes of the disease
Calcaneal fractures are the most common type of humeral fractures, accounting for about 60% of all tibiofibular fractures. Most of them fall from high places, the feet touch the ground, and the heel suffers from vertical impact.
(1) When the longitudinal fracture of the calcaneus nodule is mostly high, the bottom of the heel valgus nodule is grounded, and the medial ridge of the nodule is caused by shearing external force, which is rarely displaced and generally does not need to be treated. .
(2) The level of the calcaneus nodule (bird's beak) is a kind of avulsion fracture of the Achilles tendon. For example, the avulsed bone is small and does not affect the Achilles tendon function. For example, the fracture piece exceeds 1/3 of the nodule and has Rotating and severely tilting, or pulling up severely, can be surgically reset and screwed.
(3) When the calcaneus fracture is a varus in the foot, the carrier is caused by the impact of the talus in the lower part of the talus. It is rare and generally does not shift much. If there is displacement, it can be pushed back to the original position by the thumb. Fix with short leg cast for 4 to 6 weeks.
(4) The anterior fracture of the calcaneus is rare. The injury mechanism is strong adduction of the forefoot plus plantar flexion. The X-ray oblique slice should be taken to exclude the anterior humeral fracture of the calcaneus. The short leg cast is fixed for 4-6 weeks. Just fine.
(5) The fracture close to the joint is a fracture of the calcaneus. The injury mechanism is also high. The lower part of the talus is lowered, or the heel is caused by the counter-impact force from the bottom. The fracture line is oblique, X-ray. On the front side of the film, the fracture line is obliquely forward and backward from the inside to the back, but does not pass through the joint surface. Because the calcaneus is bone cancellous, the axial position is widened and the sides of the bone are widened; the lateral image, the calcaneus The latter half is displaced rearward with the calcaneal nodules, causing the abdomen of the calcaneus to protrude into the center of the foot into a rocking chair.
(two) pathogenesis
1. About 80% of cases with vertical pressure are caused by falling or sliding from the height. The position of the foot is different when the fall is dropped, and the direction of the force is also inconsistent, and shows different types of fracture, but basically Compression fractures are dominant, and the degree of compression varies inconsistency depending on the strength and duration of the force.
2. Direct impact is a fracture of the posterior calcaneus, which is caused by multiple external forces.
3. Muscle pull force The sudden contraction of the gastrocnemius muscle can cause the Achilles tendon to avulsion the calcaneus tuberosity. If the foot varus stress is too strong, it will cause the anterior tuberosity of the calcaneus. The valgus stress will cause the load fracture or the calcaneus knot. The longitudinal fracture of the section, but the latter is rare.
Prevention
Calcaneal fracture prevention
The disease is caused by traumatic factors, so pay attention to production and life safety, avoid trauma, and ensure personal safety is the focus of prevention of this disease. In addition, it should be noted that due to the classification of this disease, various classifications have their own advantages and disadvantages. Therefore, the doctor should comprehensively analyze the results of the plain film and CT examination in order to give a correct diagnosis and let the patient get the correct treatment in time.
Complication
Calcaneal fracture complications Complications, swelling, vascular injury
Complications of calcaneus fractures are more common, the most common are: swelling, tension blisters, compartment syndrome, neurovascular injury, wound splitting and infection, heel pain, calcaneal spur, fracture malformation, arthritis Etc. Others are limp, with contracture, lateral impact syndrome and sural neuritis.
Calcaneal fractures often involve severe soft tissue swelling and tension blisters. Blisters usually occur after fractures: severe pain in the injured foot, severe swelling, weakness in the flexor, pain in the toe, loss of the palate, tension blister or ecchymosis, etc. Severe tension swelling in the heel is an exact characteristic of the syndrome. Pressure monitoring is applied to the internal, external and superficial fascial compartments of the calcaneus. If the pressure is found to be 30 mmHg (1 mmHg = 0.133 kPa) or It should be used as an indication for surgical incision when the diastolic phase reaches 10 to 30 mmHg.
There are also:
1. Calcaneal malformation or osteogenesis is the most common sequelae. When the pressure of the calcaneus is increased, it is easy to form phlegm and pain. Because the temporal cortical unevenness stimulates the fascia and fascia, it causes pain caused by fasciitis. .
2. Patients with subtalar joint traumatic arthritis often complain of pain at the sinus sinus, and joint fusion is feasible for the confirmed patients.
3. The staped tendon tendon compression syndrome is characterized by limited local or extensive tenderness and pain during activity. It is easily misdiagnosed as a three-joint fusion of subtalar joint traumatic arthritis, but can not relieve pain. Symptoms can be alleviated by extensive removal of the calcaneal portion of the compression and release of the tendon.
4. Flexor toe tendon adhesion Claw-to-toe deformity is seen in the flexor and ham tendon, feasible tendon cutting or release.
5. Achilles tendon weakness due to nodules joint angle reduction, calcaneus nodules up to make the Achilles tendon relatively loose, walking forceless, showing foot gait, can be corrected for calcaneus osteotomy.
6. After the heel pain and pad structure destruction, fat tissue malnutrition, pain threshold decreased.
7. The nerve is embedded in the iliac crest of the posterior or sural nerve, and the lateral branch is compressed.
8. After the valgus deformity and the bone fracture, the lateral bone block is displaced outward to cause the valgus to flatten the foot, which can be used for subtalar joint fusion correction or for calcaneus osteotomy.
9. The calcaneus infection is often caused by a reduction or an open reduction. In severe cases, osteosarcoma of the calcaneus can be caused.
Symptom
Symptoms of calcaneal fractures Common symptoms Sprained foot swelling, tenderness, residual strain, lateral foot pain, heel, heel, heel, long bone stab, heel pain, tongue fracture
The patients with this disease mainly have the following performance:
1. After trauma, the heel is painful, standing and walking.
2. Local swelling, tenderness, deformity, or touching the bones.
According to the typical history of trauma, heel pain and tenderness, heel congestion, wide and flat deformity, and the outward sloping of the calcaneus, the normal sag below the external iliac crest disappears, etc. It is not difficult to make a fracture judgment. The X-ray film is mainly standard. Lateral position and axial position, when the axial position is taken, the X-ray tube should be projected at an angle of 40° to the longitudinal axis of the foot. The lateral position piece is drawn from the anterior facet of the calcaneus to the posterior articular surface, and then the posterior articular surface is drawn. To the calcaneus nodules draw a line, the two lines of intersection angle called the calcaneus nodules draw a line, the two lines of intersection angle called the calcaneus nodule angle (Böhler angle), the normal is 20 ° ~ 40 °.
Generally divided into the following 2 types:
1. Articular type refers to fractures that do not affect the joints of the heel, including:
(1) Post-calcaneus tuberosity fracture: There are also longitudinal fractures, transverse fractures and avulsion fractures.
(2) calcaneus anterior tuberosity fracture: As shown in the figure, the fracture line passes through the anterior calcaneus nodules.
(3) Transplantation fracture: It is characterized by a rupture of the calcaneus and a displacement.
(4) The fracture of the proximal joint in front of the nodule: in fact, the joint has been affected here, and attention should be paid to the treatment.
2. Articular fractures can be divided into the following 4 types depending on their morphology and degree of damage:
(1) Tongue type fracture: caused by multiple vertical violence.
(2) Depression type fracture: also caused by longitudinal vertical external force.
(3) Stump type fractures: longitudinal (oblique) fractures of the distance joint and the heel joint.
(4) Crush type fractures: mostly caused by intense compression violence.
Examine
Calcaneal fracture examination
No relevant laboratory tests.
X-ray plain film (including positive, lateral and calcane axial slices) can generally be diagnosed. CT scan or MRI can be used for patients with difficult diagnosis. Especially CT scan has a greater role in the diagnosis and prognosis of fracture classification. .
The auxiliary examination method for this disease is mainly imaging examination, and its main performances are as follows:
(1) Fracture of the calcaneus.
(2) Vertical fracture of the calcaneal nodule.
(3) bearing abrupt fractures.
(4) Compression fracture of the calcaneus.
(5) comminuted fracture of the calcaneus.
Diagnosis
Diagnosis and diagnosis of calcaneal fracture
Pathological diagnosis
The heel can be extremely swollen, the posterior sulcus becomes shallow, and the entire hind foot is swollen and tender, which is easily misdiagnosed as a sprain. X-ray examination, in addition to the lateral position of the film, should be taken with the axial image of the calcaneus to determine the type and severity of the fracture. In addition, the calcaneus is a spongy bone. There is often no clear fracture line after compression, and sometimes it is difficult to distinguish. It is often necessary to analyze the severity of the fracture according to the shape change of the bone and the measurement of the nodule-joint angle.
The patient has a typical history of trauma, suffering from foot weight and heel pain, local tenderness, swelling and subcutaneous congestion. In the case of a more severe compression fracture, except for the height of the heel and the wide diameter of the heel and the disappearance of the normal depression in the lower part of the lateral malleolus, the movement of the subtalar joint was completely lost. However, there is only local swelling and tenderness in the periarticular fractures, and the range of subtalar joint activity is normal. The x-ray positive, lateral, and axial slices can be used to determine the change in the nodule joint angle of the calcaneus and its transverse diameter.
