Conventional radiography is commonly used for initial evaluation of calcaneal injury but has the typical disadvantages of twodimensional imaging. It was named after henri mondor 18851962, a french surgeon, who described the sign in 1939 2 see also. Few studies have evaluated the relationship between ct and the brodens view for intraarticular calcaneal fracture. Additionally a ct scan of the injured foot was done in all patients for detection of the depressed fragments. Ct has changed the evaluation of calcaneal fractures because it allows better visualization of subtlar joint. Sanders proposed a new classification for calcaneal fractures based on ct findings in 1993. The role of multidetector ct in evaluation of calcaneal fractures article pdf available in egyptian journal of radiology and nuclear medicine 312 march 2015 with 159 reads how we measure. Through mpr and vr reconstruction is possible to assess accurately the fracture lines, dislocation, crushing, the morphology and the involvement of the articular surfaces, allowing to choose the appropriate treatment and have a better. Pdf sanders classification of fractures of the os calcis. The purpose of this study was to assess the incidence of tendon entrapments and tendon dislocations associated with ankle and hindfoot fractures in patients studied by multidetector computed tomography mdct.
Calcaneal fractures account for about 2% of fractures and 60% of major tarsal injuries. Axial and coronal views are obtained for proper visualization of the calcaneus, subtalar, calcaneocuboid and talonavicular joints. Sonography for identifying occult fractures may be a useful diagnostic tool, providing an accurate, highly spe. This study aimed at evaluating the role played by multidetector computed tomography in decision making in the management of extra and intraarticular fractures of the calcaneus. Multidetector ct evaluation of calcaneal fractures rsna. Sanders type iiiab calcaneal fracture without broken lateral wall. It can show the extent and extra or intraarticular components of the fracture and hematoma along the sole of the foot mondor sign. Incidence and association of ct findings of ankle tendon injuries in patients presenting with ankle and hindfoot fractures.
Modern assessment of calcaneal fractures relies heavily on multidetector computed tomography ct, which allows better visualization and characterization of fracture lines and fragment displacement. An economic evaluation of operative compared with nonoperative management of displaced intraarticular calcaneal fractures. Multidetector ct evaluation of calcaneal fractures radiographics. May 27, 2016 the purpose of this study was to assess the incidence of tendon entrapments and tendon dislocations associated with ankle and hindfoot fractures in patients studied by multidetector computed tomography mdct. Calcaneal fractures observed at ct have been divided into intra and extraarticular fractures on the basis of subtalar joint involvement. Double external fixation distraction with minimallyinvasive and percutaneous repair carl a.
Although conventional radiography is the first choice for diagnosis of. T1 computed tomographic evaluation of calcaneal fractures. Modern calcaneal fracture classification systems depend mainly on computed tomography ct because of its threedi mensional nature, rather. Calcaneal fracture wikimili, the free encyclopedia. Jan 24, 2019 a fractured calcaneus or broken heel bone tends to be an extremely disabling injury. The purpose of this paper was to determine whether lateral radiographs provide superior assessment of the displacement of the posterior facet compared. Radiography versus computed tomography for displacement. The role of multidetector ct in evaluation of calcaneal. Twentyeight patients with calcaneal fractures were included.
Therefore, treatment requires the repair of multiple fractures in the heel bone, as well as restoring the subtalar joint. Calcaneal fractures are the most common fractures of the tarsal bones, representing 2% of all fractures and accounting for 60%65% of all tarsal fractures. Evaluation of calcaneal fractures by multi detector ct and its significant effect on the surgical management planning. Three calcanei were diagnosed with sanders grade ii fracture. Our study was undertaken to assess the inter and intraobserver variability of the classification system of sanders for calcaneal fractures. The ct scan evaluation was based on sanders classification 14 that grades the calcaneal fractures according the number of the fragments and their displacement. Calcaneal fractures represent only about 2% of all fractures but 60% of fractures involving the tarsal bones modern calcaneal fracture classification systems depend mainly on computed tomography ct because of its threedimensional nature, rather than on twodimensional plain radiography as was. Calcaneal fractures evaluation and surgical treatment. Currently, orif was the preferred surgical treatment option when dealing with displaced intraarticular calcaneal fractures. Additionally, we describe particular tendon injuries associated with specific fractures. The classification of extraarticular fractures has been less controversial and makes use of anatomic landmarks on the calcaneus to divide the bone into anterior. Mri does not offer any advantage over plainradiography or highresolution multidetector ctmdct in the evaluation of associated osseousinjuries following spinal traumachance. The heel bone is like an egg with a strong shell and a soft interior.
Coronal computed tomography ct scans are commonly used in fracture classification systems for calcaneus fractures. Clinical presentation at the time of evaluation generally includes a a history of a fall from a height, and. Patients and methods twentyeight patients with calcaneal fractures were included. Jun 08, 2016 calcaneal fractures anatomy, evaluation, classification ota lecture series iv l15a duration. Original article the role of multidetector ct in evaluation of calcaneal fractures kareem mohsen moussa a, mohamed abd elfattah hassaan a, ashraf nehad moharram b, mohamed doleib elmahdi a a. Tendon injuries were seen in 25% of all ankle ct examinations, the most common fracture associated with tendon injury was pilon fracture, comprising 24. Sanders type iiiab calcaneal fracture without broken.
Multidetector ct is the best method for assessing calcaneal fractures in order to decide on the management. The result was a trend in the 1960s and 1970s that favored nonoperative management 3,6,19,23. Therefore, the heel bone often shatters when it is traumatized by a fall or accident. Over the stated period, 33 had evidence of a calcaneal fracture. Modern calcaneal fracture classification systems rely heavily on computed tomography ct because of its threedimensional approach, rather than on twodimensional conventional radiography as was used in the past 24. Imaging studies confirmed that it was a sanders type iiiab calcaneal fracture without broken lateral wall and the middle part of the posterior calcaneal articular facet collapsed. Coronal ct scans were evaluated for the classification of fractures with the. The fractures of the calcaneus could be divided in the intra and extraarticular ones.
Calcaneal fracture management via a combination of approaches. In 1720, garangeot, petit, desault, and bilgner published case reports on calcaneal fractures and advocated immobilization until solid union. We describe a modification of the classical essexlopresti manoeuvre for the indirect reduction and stabilisation of displaced intraarticular fractures of the calcaneus. The articular involvement has been associated with a poor functional outcome. Tendon entrapments and dislocations in ankle and hindfoot. All fractures that do not involve the posterior facet are included in this. This is a retrospectiveprospective study to assess the results of calcaneal fractures treated with open reduction and internal. The multidetector row ct, one of the newest modalities, signifi. Multidetector ct evaluation of calcaneal fractures. Fractures of the calcaneus present 2% of all fractured bones in humans 1. Multidetector ct with 3d reconstruction for evaluation of diagnose and treatment in calcaneal fractures abstract. Most calcaneal fractures follow a fall from height directly on to the heels. Similarly, calcaneal fractures can be difficult to image with radiographs.
Radiological and clinical assessment of calcaneal fractures. Multidetector ct is commonly used for the assessment of calcaneal fractures, and multiplanar reformation mpr has allowed accurate evaluation of fracture lines, dislocation, and comminution for the selection of appropriate treatment. Falls from a height account for 75% of these injuries, usually averaging a height of 14 feet but have been reported from as little as 3 feet 2,3. Multidetector ct with 3d reconstruction for evaluation of. Outcome of the patients who underwent minimally invasive. A calcaneal fracture is a break of the calcaneus heel bone. Surgical treatment is warranted for calcaneus fractures which are displaced or open in nature as these fractures result in damage to the internal structures of the foot, which may also need to be repaired. The age of incidence is usually between 30 and 50 years with a 5. Kurozumi t, jinno y, sato t, inoue h, aitani t, okuda k 2003 open reduction for intraarticular calcaneal fractures. Full text pdf 2590k abstracts references2 for the treatment of calcaneal fractures, determination of the disruption of the posterior subtalar joint is important. Computed tomographic evaluation of calcaneal fractures.
Ct has changed the evaluation of calcaneal fractures because it allows better. Calcaneus fracture or broken heeltreatmentrecovery. Five consultant orthopaedic surgeons with different subspecialty interests classified ct scans of 28 calcaneal fractures using this classification system. Calcaneal fracture management via a combination of. Tendon injuries are a commonly encountered finding in ankle ct examinations performed for fractures. The calcaneus is the biggest and most commonly fractured of the tarsal bones.
Original article the role of multidetector ct in evaluation of calcaneal fractures kareem mohsen moussa a, mohamed abd elfattah hassaan a, ashraf nehad moharram b, mohamed doleib elmahdi a a department of radiodiagnosis, cairo university, egypt b department of orthopedic surgery, cairo university, egypt received 15 october 2014. Calcaneus fracture or broken heeltreatmentrecoverysymptoms. In this study, we evaluated the preoperative cisruption and clinical results of 19. Ct is the modality of choice to evaluate calcaneal fracture. Ct and the use of sanders and regazzoni classification systems for the evaluation of calcaneal fractures. Surgical demonstration of technique of total knee replacement duration. Incidence and association of ct findings of ankle tendon. Badillo k, pacheco ja, padua so, gomez aa, colon e, vidal ja. Kihm, dpm management of intraarticular calcaneal fractures is complex, challenging, and evolving.
This study was designed to identify the incidence and associations of tendon injuries in ankle ct examinations performed for fractures. Extraarticular fractures are 2540% of all calcaneal fractures. Sanders type iiiab calcaneal fracture without broken lateral. The calcaneus, the more lower bone of the body, has the task of supporting the axial load from the weight of the body. It may be associated with breaks of the hip or back it usually occurs when a person lands on their feet following a fall from a height or during a motor vehicle collision. Revisit of brodens view for intraarticular calcaneal fracture. Modern calcaneal fracture classification systems rely heavily on computed tomography ct because of its threedimensional approach, rather.
Calcaneal fractures are complex injuries that commonly occur in male patients and that result in substantial morbidity. Diagnosis of a radiographically occult calcaneus fracture. With the advent of ct scanning, arbeitsgemeinschaft fu. Diagnosis is suspected based on symptoms and confirmed by xrays or ct scaning. Return to office o operative repair should occur within 3 weeks. The recovery time for severe or displaced and open fractures of calcaneus or heel bone is usually more. The object of this study was to correlate the functional outcome after treatment for displaced intraarticular calcaneal fractures with plain radiography. Therefore, surgeons need to understand the relationship between the ct images and brodens view. A fractured calcaneus or broken heel bone tends to be an extremely disabling injury. Optimal management of calcaneal fractures is controversial, as correlation between anatomical restoration and outcome is not proven, and complications after surgery are frequent. Fractures of the calcaneus remain among the most challenging fractures for the orthopaedic surgeon to effectively manage. The radiological and functional results achieved using this technique in 15 patients is presented. Calcaneal fractures represent about 12% of all fractures and 60% of the tarsal bones fractures. Treatment of displaced intraarticular calcaneal fractures with closed reduction and percutaneous screw fixation.
This article placed suspicion on the operative treatment of calcaneus fractures once again. Its presence is considered pathognomonic for a calcaneal fracture 1. It was named after henri mondor 18851962, a french surgeon, who described the sign in 1939 2. Kappa statistics were used to analyse the two groups. Ultrasonographic diagnostics and evaluation of calcaneal. Ten tongueshaped and 8 joint depression type fractures were treated by the new method, incorporating the use of an additional. Sep 15, 2017 ct has changed the evaluation of calcaneal fractures because it allows better visualization of subtlar joint. Orif of intraarticular calcaneal fracture with the locking calcaneal. N2 computed tomography ct can be a useful adjunct to conventional radiographs in the evaluation and treatment planning of comminuted calcaneal fractures. Intraarticular fractures are often classified using the sander classification system, which is one of the only systems that correlate well with. Haapamaki et al 8 reported sensitivity of 87% for radiography for calcaneal fractures compared to multidetector ct. Calcaneal fractures represent only about 2% of all fractures but 60% of fractures involving the tarsal bones 1. Use of multidetector ct has allowed the development of classification sys. Symptoms may include pain, bruising, trouble walking, and deformity of the heel.
Incidence and association of ct findings of ankle tendon injuries in patients presenting with ankle and. A ct scan is currently the imaging study of choice for evaluating calcaneal injury and has substituted conventional radiography in the classification of calcaneal fractures. However, they may not accurately reflect the amount of fracture displacement. Schuberth calcaneal fractures account for about 2% of fractures and 60% of major tarsal injuries 1. Evaluation of calcaneal fractures by multi detector ct and its. Historically, these injuries have fared poorly with or without surgical intervention 1. The role of multidetector ct in evaluation of calcaneal fractures. An operation for relief of disability in old fractures of os calcis.
Calcaneal fractures anatomy, evaluation, classification ota lecture series iv l15a duration. Badillo k, pacheco ja, padua so, gomez aa, colon e, vidal ja using computed tomography. Evaluation and classification of calcaneal fractures based. Modified essexlopresti westheus reduction for displaced. Modern assessment of calcaneal fractures relies heavily on multidetector ct, which allows better visualization and characterization of fracture lines and fragment displacement. Calcaneal fractures evaluation and surgical treatment youtube. Fracture of calcaneus sanders ct classification of intra. Its presence is considered pathognomonic for a calcaneal fracture 1 history and etymology. His plain x rays and ct scan showed an intraarticular fracture sanders type iiiac of the left calcaneus. Oct 28, 2019 a ct scan is currently the imaging study of choice for evaluating calcaneal injury and has substituted conventional radiography in the classification of calcaneal fractures. It is thought that the scan may delineate the fracture fragments better and help in making the preoperative planning of the fracture. The mondor sign is a sign seen clinically and on ct, and refers to a hematoma that is formed and extends distally along the sole of the foot 1. Jan 01, 2011 modern assessment of calcaneal fractures relies heavily on multidetector computed tomography ct, which allows better visualization and characterization of fracture lines and fragment displacement.
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