Heel congestion
Introduction
Introduction The typical symptom of a calcaneal fracture is heel congestion.
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) 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. It is rarely shifted and generally does not need to be processed.
(2) The level of calcaneus nodule (bird's beak) is a kind of avulsion fracture of 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) When the calcaneus fracture is a varus, 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 the short leg plaster is fixed for 4 to 6 weeks.
(4) The fracture of the anterior calcaneus is 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) The fracture close to the joint is a fracture of the calcaneus. The injury mechanism is also caused by the high point falling down with the bone, or the heel being affected by 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. About 80% of cases with vertical pressure 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 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.
Examine
an examination
Related inspection
Joint examination
First, the symptoms:
The patients with this disease mainly have the following performance:
1. After trauma, heel pain, unfavorable standing and walking.
2. Local swelling, tenderness, deformity, or bone rubbing.
According to the typical history of trauma, heel pain and tenderness, heel congestion, wide and flat deformity, and the outward slanting of the calcaneus, the normal sag below the lateral iliac crest, etc., it is not difficult to make a fracture judgment. The X-ray film is mainly the standard lateral position and the axial position piece. When the axial position piece is taken, the X-ray tube should be projected at an angle of 40° with the longitudinal axis of the foot. The lateral position piece draws a line from the anterior facet of the calcaneus to the posterior articular surface. Then, draw a line from the posterior articular surface to the calcaneus nodule. The two-line intersection angle is called the calcaneus nodule. The two-line intersection angle is called the calcaneus nodule angle (Böhler angle), and 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 nodular 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.
Second, the diagnosis:
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.
Diagnosis
Differential diagnosis
Differential diagnosis of heel congestion:
1. Red lumps of pain in the posterior upper part of the heel: Achilles bursitis in the Achilles tendon appears as a red mass with pain in the upper back of the heel.
2, the toes are cold and cold, showing pale or purple: the toes are cold and cold, and the pale or purple is the clinical manifestation of occlusive thromboangiitis, thromboembolic angiitis (thrombosis angiitis) Obliterans, tao) is a kind of vascular inflammation that is different from arteriosclerosis and segmental distribution. The lesions mainly involve small and medium arteries and veins in the distal segment of the extremities. The pathologically mainly characterized by inflamed thrombus of characteristic inflammatory cells, and less blood vessels. The wall is affected.
