tongue fracture
Introduction
Introduction Tongue type A type of fracture of the calcaneus, caused by vertical violence. Calcaneal fractures are the most common type of humeral fractures, accounting for approximately 60% of all tibiofibular fractures. Most fall from the height, the foot touches the ground, and the heel suffers from vertical impact.
Cause
Cause
(1) Causes of the disease
Calcaneal fractures are the most common type of humeral fractures, accounting for approximately 60% of all tibiofibular fractures. Most fall from the height, the foot touches the ground, and the heel suffers from vertical impact.
(1) Longitudinal fracture of the calcaneus nodules: When the height is lowered, the bottom of the heel valgus nodule is grounded, and the medial ridge of the nodule is caused by shearing external force. It is rarely shifted and generally does not need to be processed.
(2) Calcaneal nodule level (bird's beak) fracture: a type of avulsion fracture of the Achilles tendon. If the avulsed bone is small, it will not affect the Achilles tendon function. If the fracture piece exceeds 1/3 of the nodule, and there is rotation and severe inclination, or if the upward traction is severe, the operation can be reset and the screw is fixed.
(3) calcaneus shoulder fracture: When the foot is turned over, the carrier is caused by the impact of the talus in the lower part of the talus. It is rare. Generally, there is not much displacement. If there is displacement, the thumb can be used to push it back to the original position, and it is fixed with short leg cast for 4 to 6 weeks.
(4) Fracture of the anterior calcaneus: less common. The injury mechanism is a strong adduction of the forefoot plus a plantar flexion. The X-ray oblique slice should be taken to exclude the anterior humeral fracture of the calcaneus, and the short leg cast can be fixed for 4-6 weeks.
(5) Fracture close to the joint joint: for the fracture of the calcaneus, the damage mechanism is also caused by the high point falling down with the bone, or the heel being subjected to the counter-impact force from below. The fracture line is oblique. When the X-ray film is viewed from the front, the fracture line is inclined from the inside to the outside, but not through the joint surface. Because the calcaneus is cancellous, the axial position is widened on both sides of the humerus; the lateral image, the posterior half of the calcaneus and the calcaneal nodule are displaced backwards, causing the calcaneus to protrude to the center of the foot. It is rocking chair.
(two) pathogenesis
1. Vertical pressure: About 80% of cases are caused by falling or sliding from height. Depending on the position of the foot when it falls, the direction of its force is also inconsistent, and it shows different types of fracture, but it is mainly based on compression fracture. In addition, depending on the strength and duration of the force, the degree of compression changes inconsistency.
2. Direct impact: It is a fracture of the posterior calcaneus, which is caused by multiple external forces.
3. Muscle pull: 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 avulsion of the anterior calcaneus; and the valgus stress will cause the load fracture or calcaneus. Longitudinal fracture of the nodule, but the latter is rare.
Examine
an examination
Related inspection
X-ray lipiodol imaging super-image bone palpation
The patient's 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 radiograph, 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 usually 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. Only individual cases require CT scan or MRI.
X-ray plain film (including positive, lateral and calcaneus axial slices) can generally be diagnosed. CT scan or MRI can be performed in patients with difficult diagnosis. Especially CT scan has a greater role in the diagnosis and prognosis of fracture classification. .
The auxiliary examination method of this disease is mainly imaging examination, and its main manifestations are: (1) calcaneus protrusion. (2) Vertical fracture of the calcaneal nodule. (3) bearing abrupt fractures. (4) Compression fracture of the calcaneus. (5) comminuted fracture of the calcaneus.
Diagnosis
Differential diagnosis
Differential diagnosis
Calcaneal osteomyelitis: The main cause of this disease is rapid onset, often accompanied by high fever and swelling of the calcaneal. Due to increased intraosseous pressure, the calcaneus is severely painful, tender and painful. Early tomographic or CT scans showed a focal density reduction zone. Because it is a cancellous bone, blood supply is abundant, and few dead bones are formed. As the lesion progresses, there may be more calcium deposition and new bone formation, and the bone density increases.
Calcaneal Spur Syndrome: Heel pain on the X-ray with or without spurs due to heel pain in the sub-femoral region caused by the plantar fascia on the periosteum. Bone spurs are caused by excessive traction of the periosteum at the attachment of the plantar fascia to the calcaneus. Excessive traction causes pain in the inner edge of the plantar fascia (plantar fasciitis). The lesions that cause tension in the fascia are flat and axillary.
