This fracture occurs as a result of the Achilles tendon, which is extremely strong, avulsing a posterior fragment which may be either intra- or extraarticular. Occasionally, it is completely extraarticular but deserves the same operative treatment and reduction. Type II or beak fractures are uncommon. Intraarticular fractures of the calcaneus: diagnosis and surgical management. Fig. https://doi.org/10.1007/s10140-018-1629-4. 2004 Sep;35 Suppl 2:SB55-63. 8,10 They can occur as an isolated fracture line or as part of a more complex, intra-articular calcaneus fracture pattern. Careers. 2022 Sep 14;34:282-287. doi: 10.1016/j.jor.2022.09.009. Intra-articular tongue-type fractures of the calcaneus: anatomy, injury patterns, and an approach to management. Closed Reduction and Percutaneous Fixation of Calcaneal Fractures in Children. 2021 Nov 9;11:59. doi: 10.25259/JCIS_142_2021. Surgical treatment of intraarticular fractures of the calcaneus: comparison between flat plate and calcaneal plate. Syros A, Perez J, Hodgens BH, Boden AL, Constantinescu DS, Smith B, Davies JP, Steinlauf S. J Orthop. Epub 2016 Sep 19. Materials and Methods A total of 77 patients with intra-articular tongue-type calcaneal fractures between September 2015 and July 2019 were included in this study. government site. Patients/participants: Fifty-six displaced Sanders 2B and 2C tongue-type calcaneus fractures identified from an initial cohort of 1118 . 2016 Jul 1;39(4):e744-8. Discussion: 2007 Mar;12(1):107-23. doi: 10.1016/j.fcl.2006.12.003. 8600 Rockville Pike Radiographics. An official website of the United States government. Management of calcaneal tuberosity fractures. The emergent nature of this entity has received little attention in the radiology literature. Of 954 patients with calcaneal fractures, 139 tongue-type calcaneus fractures in 127 patients formed the study group. 2005 Sep-Oct;25(5):1215-26. doi: 10.1148/rg.255045713. Calcaneal fractures have characteristic appearances based on the mechanism of injury and are divided into two major groups, intraarticular and extraarticular. Epub 2022 Jan 5. White. 2008 Dec;75(6):457-64. -, Emerg Radiol. MeSH 10,18 Feng Y, Yu Y, Shui X, Ying X, Cai L, Hong J. Orthopedics. Before Radiographics 31(1):8192, Essex-Lopresti P (1993) The mechanism, reduction technique, and results in fractures of the os calcis, 1951-52. Bookshelf Most calcaneal fractures (70%-75%) are intraarticular and result from axial loading that produces shear and compression fracture lines. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. Design: Retrospective cohort. Am J Emerg Med. Fracture lines can be seen near the Achilles tendon attachment and the posterior facet of the calcaneus (intra-articular). (Fig.1).1). -, AJR Am J Roentgenol. Tongue-type fractures of the calcaneus lead to variable amounts of displacement of the posterior tuberosity. Federal government websites often end in .gov or .mil. Foot 19(4):197200, Article Setting: Clipboard, Search History, and several other advanced features are temporarily unavailable. It is primarily based on radiographic findings and distinguishes intraarticular fracture patterns into two types (depending on the exit point of the secondary fracture line): "tongue type" and "joint depression" fractures [ 2] [ Figure 1 ]. Am J Emerg Med 31(7):1151.e11531151.e1154, Daftary A, Haims AH, Baumgaertner MR (2005) Fractures of the calcaneus: a review with emphasis on CT. Radiographics 25(5):12151226, Gardner MJ, Nork SE, Barei DP, Kramer PA, Sangeorzan BJ, Benirschke SK (2008) Secondary soft tissue compromise in tongue-type calcaneus fractures. and transmitted securely. Intra-articular tongue-type fractures of the calcaneus: anatomy, injury patterns, and an approach to management. eCollection 2021. Foot 27:13, Ballard DH, Campbell KJ, Blanton LE, Williams JT, Sangster G, Hollister AM, Simoncini AA (2016) Tendon entrapments and dislocations in ankle and hindfoot fractures: evaluation with multidetector computed tomography. This requires the emergency physician to understand the radiographic morphology of the fracture as well as the clinical signs of skin compromise. Careers. 8600 Rockville Pike PMC Delayed Soft Tissue Necrosis in an Atypical Closed Calcaneal Fracture: A Case Report. Intra-articular tongue-type fractures may develop skin breakdown and often require urgent surgical reduction and fixation. https://doi.org/10.1007/s10140-018-1629-4, DOI: https://doi.org/10.1007/s10140-018-1629-4. PMC Foot Ankle Clin 12(1):107123, Wang CL, Cheng CK, Chen CW, Lu CM, Hang YS, Liu TK (1995) Contact areas and pressure distributions in the subtalar joint. University level I trauma center. PubMed Results: Six soft tissue coverage procedures and one amputation resulted. PMC This site needs JavaScript to work properly. The https:// ensures that you are connecting to the Design: Open all credits. Bhler angle Annotated image Annotated image Lateral (annotated) Reduced Bhler angle is shown in red. Traditionally, tongue-type calcaneal fractures have been treated using screw fixation or tension band wiring. Overall tongue type calcaneal fractures tend to have a more favourable prognosis when compared to articular depression patterns and perhaps not surprisingly treating these injuries with percutaneous techniques also offers advantage. Am J Emerg Med 26(2):254 e251, Article A contemporary review. Clin Interv Aging. Epub 2017 Dec 11. Authors of section Authors. -, Radiographics. MeSH Description of Extreme tongue-type (beak) fracture of the calcaneus body. Gardner MJ, Nork SE, Barei DP, Kramer PA, Sangeorzan BJ, Benirschke SK. doi: 10.1016/j.ajem.2007.04.033. J Orthop Trauma 22(7):439445, Hess M, Booth B, Laughlin RT (2008) Calcaneal avulsion fractures: complications from delayed treatment. This site needs JavaScript to work properly. The https:// ensures that you are connecting to the b Sagittal CT shows the fracture extends into the posterior facet with minimal displacement (arrow) - "Intra-articular tongue-type fractures of the calcaneus: anatomy, injury patterns, and an approach to management" Skin compromise complicates a large percentage of these injuries because of the thin layer of soft tissue and superficial nature of the fracture. Cao Y, Xu X, Guo Y, Cui Z, Zhao Y, Gao S, Tian Y, Lv Y, Zhou F. Front Surg. Objective: To define the pathoanatomy of the tongue-type calcaneus fracture and assess the appropriateness of percutaneous techniques in addressing all planes of deformity in this injury. PubMed Keywords: Accessibility Injury. Please enable it to take advantage of the complete set of features! 2 Normal lateral radiograph of the calcaneus. Disclaimer, National Library of Medicine J Nepal Health Res Counc. The site is secure. Results: The .gov means its official. In preparation for the procedure, the patient is positioned and anesthesia is administered. 2005 Sep-Oct;25(5):1215-26 Google Scholar, Greenspan A (2014) Orthopedic imaging: a practical approach: Lippincott Williams & Wilkins, Bohl DD, Ondeck NT, Samuel AM, Diaz-Collado PJ, Nelson SJ, Basques BA, Leslie MP, Grauer JN (2017) Demographics, mechanisms of injury, and concurrent injuries associated with calcaneus fractures: a study of 14 516 patients in the American College of Surgeons National Trauma Data Bank. An 2017 Jan;52(1):28-33. doi: 10.1016/j.jemermed.2016.07.085. Richard Buckley, Andrew Sands. J Orthop Trauma. A joint-preserving osteotomy with axial realignment is a treatment option for malunited tongue-type calcaneal fractures encountered early on, before the development of . This procedure is used to correct a "tongue-type" fracture of the calcaneus (the heel bone). This site needs JavaScript to work properly. 2019 Feb;26(1):67-74. doi: 10.1007/s10140-018-1629-4. 2015 Nov;205(5):1061-7. doi: 10.2214/AJR.14.14190. Share. J Orthop Trauma 20(9):618622, Tornetta P 3rd. Secondary soft tissue compromise in tongue-type calcaneus fractures. Acta Radiol 51(4):438454, Soeur R, Remy R (1975) Fractures of the calcaneus with displacement of the thalamic portion. Google Scholar, Sanders R, Vaupel ZM, Erdogan M, Downes K (2014) Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 years) results in 108 fractures using a prognostic CT classification. Eur Rev Med Pharmacol Sci 19(22):42204226, CAS An official website of the United States government. Patients/participants: Patient demographics, comorbidities, injury mechanism, fracture displacement, and time to presentation were evaluated. During this procedure, the surgeon stabilizes the bone with hardware to allow the bone to heal properly. Type III (20%) are oblique fractures. A staged treatment plan for the management of Type II and Type IIIA open calcaneus fractures. Mehta S, Mirza AJ, Dunbar RP, Barei DP, Benirschke SK. 2019 Feb;26(1):67-74. doi: 10.1007/s10140-018-1629-4. Curr Probl Diagn Radiol 36(1):110, Carr JB (1993) Mechanism and pathoanatomy of the intraarticular calcaneal fracture. Bethesda, MD 20894, Web Policies Please enable it to take advantage of the complete set of features! volume26,pages 6774 (2019)Cite this article. Clipboard, Search History, and several other advanced features are temporarily unavailable. FOIA Tongue-type fractures are unusual calcaneal fractures that produce an unique and relatively uncommon injury pattern to the bone and soft tissues, due to the separation of the calcaneal tuberosity into superior and inferior fragments. 2006 Oct;20(9):618-22. doi: 10.1097/01.bot.0000249420.30736.91. Please enable it to take advantage of the complete set of features! Intra-articular tongue-type fractures may develop skin breakdown and often require urgent surgical reduction and fixation. Foot Ankle 6(4):184193, Wong-Chung J, O'Longain D, Lynch-Wong M, Julian H (2016) Irreducible tongue-type calcaneal fracture due to interposition of flexor hallucis longus. Allegra PR, Rivera S, Desai SS, Aiyer A, Kaplan J, Gross CE. PMC The purpose of this study was to determine the incidence of posterior skin involvement in tongue-type calcaneus fractures and to determine the patient and fracture characteristics that lead to high-risk situations. 2006 May;12(4):171-6 The .gov means its official. The https:// ensures that you are connecting to the White, E.A., Skalski, M.R., Matcuk, G.R. this may result in a tongue-type calcaneus fracture (or a de- pressedvariant)[20,23](Fig.3).Thetongue-typefracturecan result in superior and posterior displacement of the displaced Clin Orthop Relat Res 290:316, Qiang M, Chen Y, Zhang K, Li H, Dai H (2014) Measurement of three-dimensional morphological characteristics of the calcaneus using CT image post-processing. Emerg Radiol. This calcaneus fracture is a tongue-type injury and associated with significant soft-tissue compromise. J Bone Joint Surg Br. Calcaneal avulsion fractures: complications from delayed treatment. Clin Orthop Relat Res 290:3640, Mitchell MJ, McKinley JC, Robinson CM (2009) The epidemiology of calcaneal fractures. 2022 Apr 4;9:854210. doi: 10.3389/fsurg.2022.854210. Those injuries that were associated with posterior, secondary soft tissue breakdown were identified and compared to those without breakdown. CAS fracture line when a longitudinal tongue-type fracture line traverses the lateral calcaneus, characterizing joint depres-sion fractures, and fully delineating intra-articular fracture involvement of the anterior process [5]. and transmitted securely. 2016 Dec 29;52(1):29-34. doi: 10.1016/j.rboe.2016.05.007. Occasionally, it is completely extraarticular but deserves the same operative treatment and reduction. ACS Level I trauma center. Recognition of the imaging findings, accurate interpretation, and timely communication may prevent devastating clinical outcomes including soft tissue coverage procedures and amputation. FOIA FOIA Those with threatened posterior skin who were treated emergently with percutaneous reduction did not progress to soft tissue compromise. sharing sensitive information, make sure youre on a federal Open wounds occur with calcaneus fracture from direct application of force and from tearing along the medial side of the fracture as the tuberosity displaces laterally. Intra-articular Calcaneus Fractures: Current Concepts Review. The normal value for the angle of Gissane is between 120 and 145 - "Intra-articular tongue-type fractures of the calcaneus: anatomy, injury patterns, and an approach to management" Eric A. Preparation. The .gov means its official. This fracture occurs as a result of the Achilles tendon, which is extremely strong, avulsing a posterior fragment which may be either intra- or extraarticular. -. Part of Springer Nature. Bethesda, MD 20894, Web Policies 2022 Jan 21;17(1):39. doi: 10.1186/s13018-022-02930-y. Main outcome measurements: 8600 Rockville Pike J Foot Ankle Surg. PubMed sharing sensitive information, make sure youre on a federal This article reviews the anatomy of the calcaneus, as well as the clinical presentation and imaging findings of intra-articular tongue-type fractures. Would you like email updates of new search results? Yu Q, Li Z, Li J, Yu Q, Zhang L, Liu D, Zhang M, Tang P. J Orthop Surg Res. Google Scholar, Matherne TH, Tivorsak T, Monu JU (2007) Calcaneal fractures: what the surgeon needs to know. Disclaimer, National Library of Medicine Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. Google Scholar, Walters JL, Gangopadhyay P, Malay DS (2014) Association of calcaneal and spinal fractures. Setting: Sanders 2B fractures were more likely to be in a position of valgus and adduction than those of 2C fractures. CAS If it is not reduced accurately, weakness from Achilles tendon dysfunction will occur. Before 1990 Oct;13(10):1091-100. doi: 10.3928/0147-7447-19901001-05. Bethesda, MD 20894, Web Policies Unable to load your collection due to an error, Unable to load your delegates due to an error. The authors declare that they have no conflict of interest. 2013 Jan;11(23):70-5. type 2c: involves one primary fracture line that courses through the medial aspect of the posterior facet and is accompanied by a transverse fracture through the body of the calcaneus; this fracture is often accompanied by one or more accessory fracture lines that do not involve the posterior articular facet Objectives: Open wounds occur with calcaneus fracture from direct application of force and from tearing along the medial side of the fracture as the tuberosity displaces laterally. eCollection 2021. Before When assessing for displacement and angulation in the coronal plane, 98% of tongue fragments were either in a position of valgus (77%) or neutral (21%), with a mean valgus angulation of 17.3 degrees. Disclaimer, National Library of Medicine Calcaneus Fractures: A Possible Musculoskeletal Emergency. All tongue-type calcaneus fractures treated at 1 institution between 2002 and 2007 were identified from a trauma registry. In the axial plane, 98% of tongue pieces were in a position of adduction (64%) or neutral (34%), with an average angulation into adduction of 15.0 degrees. Emerg Radiol 26, 6774 (2019). Journal of foot and ankle research 7(1):19, Article Accessibility Unable to load your collection due to an error, Unable to load your delegates due to an error. The Essex-Lopresti classification system was developed in 1952. Bhler angle From the case:Calcaneal fracture - tongue-type Annotated image Loading Stack - Type I (20%) the fracture line may be through the tuberosity, the sustentaculum tali, or the anterior process of the calcaneus. J Orthop Trauma 12(7):469473, Benito-Ruiz J, Yoon T, Guisantes-Pintos E, Monner J, Serra-Renom JM (2004) Reconstruction of soft-tissue defects of the heel with local fasciocutaneous flaps. A reduced Bhler angle is noted (see annotated image below). and transmitted securely. 2021 Nov 9;11:59. doi: 10.25259/JCIS_142_2021. Type V fractures are comminuted fractures with a centrally depressed fragment. White EA, Skalski MR, Matcuk GR Jr, Heckmann N, Tomasian A, Gross JS, Patel DB. This article reviews the anatomy of the calcaneus, as well as the clinical presentation and imaging findings of intra-articular tongue-type fractures. Ideally, the CT scans are formatted in two planes: the semicoronal or oblique coronal plane, which is perpendicular . Extreme tongue-type (beak) fracture of the calcaneus body. These injuries require urgent reduction and fixation in order to minimize soft tissue compromise from the pressure of the displaced tuberosity fragment on the posterior heel skin. 2010 Mar;24(3):142-7. doi: 10.1097/BOT.0b013e3181b5c0a4. A recent retrospective cohort study by Quirine showed a lower incidence of wound problems and deep infection when . Although mechanism, displacement, and time to presentation were significantly correlated with posterior skin involvement, the surgeon should be aware of this potential complicating factor in all tongue-type fractures. eCollection 2022 Nov-Dec. Cursaru A, Creu B, erban B, Iordache S, Popa M, Smarandache CG, Orban C, Crstoiu C. Exp Ther Med. An official website of the United States government. They are often superiorly displaced because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex. Twenty-nine fractures (21%) had some degree of posterior skin compromise at presentation, including 12 with threatened skin, 10 with partial thickness breakdown, and 7 with full thickness breakdown. 2022 Apr 4;9:854210. doi: 10.3389/fsurg.2022.854210. Unable to load your collection due to an error, Unable to load your delegates due to an error. 2020 Jul 28;5(3):2473011420927334. doi: 10.1177/2473011420927334. AJR Am J Roentgenol 158(6):12711274, Rubino R, Valderrabano V, Sutter PM, Regazzoni P (2009) Prognostic value of four classifications of calcaneal fractures. Intra-articular tongue-type fractures may develop skin breakdown and often require urgent surgical reduction and fixation. Ankle radiographs revealed a tongue-type calcaneal fracture. Clin Orthop Relat Res 30:6466, Article Bilateral fractures of the calcaneus occur approximately 10% of the time. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. J Clin Imaging Sci. J Orthop Trauma. Computed Tomography for Calcaneal Fractures: Adding Value to the Radiology Report. Knowledge of this deformity may aid in achieving successful closed reduction when using the Essex-Lopresti maneuver or other less invasive techniques. FOIA Anyone you share the following link with will be able to read this content: Sorry, a shareable link is not currently available for this article. Main outcome measurements: Soft tissue complications following calcaneal fractures. official website and that any information you provide is encrypted J Foot Ankle Surg 56(5):11141120, Sharr PJ, Mangupli MM, Winson IG, Buckley RE (2016) Current management options for displaced intra-articular calcaneal fractures: non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. (1998) The Essex-Lopresti reduction for calcaneal fractures revisited. 2021 Feb 15;16:275-280. doi: 10.2147/CIA.S291497. Treatment included lag screw fixation to maintain the reduction without further soft-tissue trauma. The pressure of the displaced fragment compromising blood flow to the overlying soft tissues is reflected by the ecchymosis and skin blanching present at the time of presentation. 2014 Oct;28(10):551-63. doi: 10.1097/BOT.0000000000000169. Skelet Radiol 45(7):977988, Strauss EJ, Petrucelli G, Bong M, Koval KJ, Egol KA (2006) Blisters associated with lower-extremity fracture: results of a prospective treatment protocol. J Bone Joint Surg Br 57(4):413421, Badillo K, Pacheco JA, Padua SO, Gomez AA, Colon E, Vidal JA (2011) Multidetector CT evaluation of calcaneal fractures. Fig. doi: 10.3928/01477447-20160421-05. 1975 Nov;57(4):413-21 Snoap T, Jaykel M, Williams C, Roberts J. J Emerg Med. Banerjee R, Chao JC, Taylor R, Siddiqui A. J Am Acad Orthop Surg. and osteoarticular radiology . Publication types Case Reports MeSH terms Accidental Falls Bone Screws Calcaneus / diagnostic imaging J Clin Imaging Sci. Types IV and V(60%) involve the subtalar joint. Patients with posterior skin compromise were less likely to have a fall mechanism (P = 0.001), had significantly greater fracture displacement (P = 0.007), were more likely to smoke (P = 0.039), and were more frequently referred on a delayed basis (P = 0.007). They are often superiorly displaced because of the insertion of the Achilles tendon and pull of the gastroc-soleus complex. Foot Ankle Int 30(3):229238, Johnson PT, Fayad LM, Fishman EK (2006) Sixteen-slice CT with volumetric analysis of foot fractures. - 46.32.249.112. HHS Vulnerability Disclosure, Help Discussion: Tongue-type calcaneal fractures and tuberosity fractures must be triaged appropriately within the first few hours of presentation to prevent skin compromise. 53(3):279281, Janzen DL, Connell DG, Munk PL, Buckley RE, Meek RN, Schechter MT (1992) Intraarticular fractures of the calcaneus: value of CT findings in determining prognosis. HHS Vulnerability Disclosure, Help government site. 2018 Feb;49(2):425-429. doi: 10.1016/j.injury.2017.12.008. Secondary soft tissue injury can also occur from pressure of the displaced fracture fragments. Clipboard, Search History, and several other advanced features are temporarily unavailable. Clipboard, Search History, and several other advanced features are temporarily unavailable. The https:// ensures that you are connecting to the Early recognition by the emergency physician and prompt operative repair prevent further injury and obviate the need for surgical soft tissue coverage or potential amputation. Calcaneal fracture; Computed tomography; Musculoskeletal; Radiography; Tongue-type fracture; Trauma. doi: 10.1016/j.injury.2004.07.012. Foot Ankle Clin. Because many calcaneus fractures are splinted initially and immobilized for several weeks until swelling resolves, failure to acutely recognize the potential for posterior skin breakdown may lead to severe soft tissue morbidity. J Orthop Trauma. Secondary soft tissue injury can also occur from pressure of the displaced fracture fragments. Foot Ankle Spec 10(5):402410, Article Fractures of the calcaneus: a review with emphasis on CT. Calcaneal fracture maps and their determinants. Soft tissue complications and timing of surgery in patients with a tongue-type displaced intra-articular calcaneal fracture: An international retrospective cohort study. An official website of the United States government. 2012 Apr;20(4):253-8. doi: 10.5435/JAAOS-20-04-253. official website and that any information you provide is encrypted MeSH Recognition of the imaging findings, accurate interpretation, and timely communication may prevent devastating clinical outcomes including soft tissue coverage procedures and amputation. The Essex-Lopresti reduction for calcaneal fractures revisited. Emergency Radiology Computed Tomography for Calcaneal Fractures: Adding Value to the Radiology Report. Emerg Radiol 12(4):171176, Gilmer PW, Herzenberg J, Frank JL, Silverman P, Martinez S, Goldner JL (1986) Computerized tomographic analysis of acute calcaneal fractures. In this work, we aim to present a technique guide for an alternative approach to fixation of these fractures given the high potential for failure with traditional methods. A 62-year-old female with tongue-type calcaneal fracture due to minor trauma is presented, which is often associated to high-energy injuries in younger individuals. eCollection 2017 Jan-Feb. Objective: Tongue-type fractures are unusual calcaneal fractures in which the displacement of a bony fragment has the potential to tent the skin of the posterior heel. Calcaneal fractures account for 60% of all tarsal bone fractures. A high incidence (21%) of posterior skin compromise occurs in tongue-type calcaneus fractures. government site. Bookshelf . Download Citation | Tongue-Type Calcaneus Fractures | Tongue-type calcaneus fractures present a challenge to orthopedic surgeons. A case of a tongue-type calcaneus fracture with a posteromedial dislocation of the calcaneal posterior facet and tuberosity is presented. This site needs JavaScript to work properly. Imaging interpretation and clinical management of these fractures are discussed. Fracture lines can be seen near the Achilles tendon attachment and the posterior facet of the calcaneus (intra-articular). Executive Editors. PubMedGoogle Scholar. Displacement of the sustentacular fragment in intra-articular calcaneal fractures. J Emerg Med 52(1):2833, Watson TS (2007) Soft tissue complications following calcaneal fractures. Unable to load your collection due to an error, Unable to load your delegates due to an error. Modification of the sinus tarsi approach for open reduction and plate fixation of intra-articular calcaneus fractures: the limits of proximal extension based upon the vascular anatomy of the lateral calcaneal artery. Calcaneal fractures account for 60% of all tarsal bone fractures. This displacement may threaten the posterior soft tissue envelope. The management of this fracture is distinctly different from other calcaneal fractures, as urgent surgery may be required [ 12 ]. The site is secure. The subtalar joint is crucial for normal foot and ankle function. PubMed Central Tongue-type fractures are unusual calcaneal fractures that produce an unique and relatively uncommon injury pattern to the bone and soft tissues, due to the separation of the calcaneal tuberosity into superior and inferior fragments. J Orthop Trauma 9(3):251258, Calleja M, Connell DA (2010) The Achilles tendon. 2008 Aug;22(7):439-45. doi: 10.1097/BOT.0b013e31817ace7e. Rev Bras Ortop. Minimally invasive treatment and internal fixation vs. extended lateral approach in calcaneus fractures of thalamic interest. Semin Musculoskelet Radiol 14(3):307322, Pierre-Jerome C, Moncayo V, Terk MR (2010) MRI of the Achilles tendon: a comprehensive review of the anatomy, biomechanics, and imaging of overuse tendinopathies. AJR Am J Roentgenol 208(2):373379, Tresley J, Subhawong TK, Singer AD, Clifford PD (2016) Incidence of tendon entrapment and dislocation with calcaneus and pilon fractures on CT examination. official website and that any information you provide is encrypted Would you like email updates of new search results? Setting: ACS Level I trauma center. Tongue-type fractures of the calcaneus lead to variable amounts of displacement of the posterior tuberosity. The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures 2 and ~60% of all tarsal fractures 3. Sanders et al.'s [13] original description of intraarticular calcaneal fracture classification was based on coronal and axial CT cross-sections with the widest undersurface of the posterior facet of the talus (Fig. Epub 2018 Jul 30. Acta Chir Orthop Traumatol Cech. Tongue-type calcaneus fractures are longitudinal fractures that exit the calcaneal tuberosity posteriorly and involve a portion of the articular surface. Due to the potential for soft-tissue compromise these injuries can . Sinus tarsi approach in high-risk patients with displaced intra-articular calcaneus fractures: A case series. HHS Vulnerability Disclosure, Help Ann Plast Surg 52(4):380384, Khai Luen K, Wan Sulaiman WA (2017) Functional outcomes after heel pad reconstruction: a review of 7 cases. eCollection 2022. In selected cases, if the malunited joint is still in good condition, it is preserved by corrective osteotomy. Bethesda, MD 20894, Web Policies Univariate analysis and stepwise multinomial logistic regressions were used to identify significant predictors of posterior soft tissue compromise. Several radiographic features of intra-articular fractures have been shown to correlate with the outcome. White,George R. Matcuk Jr,Nathanael Heckmann,Anderanik Tomasian,Jordan S. Gross&Dakshesh B. Patel, Palmer College of Chiropractic, West Campus, San Jose, USA, You can also search for this author in Cao Y, Xu X, Guo Y, Cui Z, Zhao Y, Gao S, Tian Y, Lv Y, Zhou F. Front Surg. The site is secure. eCollection 2021. Retrospective cohort. Management of intra-articular fracture of calcaneus by combined percutaneous and minimal internal fixation. 2022 Springer Nature Switzerland AG. Femino JE, Vaseenon T, Levin DA, Yian EH. [Long-term results of calcaneal fracture treatment by open reduction and internal fixation using a calcaneal locking compression plate from an extended lateral approach]. The Treatment of Avulsion Fracture of the Calcaneal Tuberosity: A New Technique of 180-Degree Annular Internal Fixation. Early recognition by the emergency physician and prompt operative repair prevent further injury and obviate the need for surgical soft tissue coverage or potential amputation. Operative treatment of displaced intraarticular calcaneal fractures: long-term (10-20 Years) results in 108 fractures using a prognostic CT classification. Would you like email updates of new search results? Learn more about Institutional subscriptions, Stoller DW, Tirman PF, Bredella MA, Beltran S (2004) Diagnostic imaging: orthopaedics: Amirsys Salt Lake City, Eiff MP, Hatch R, Higgins MK (2012) Fracture management for primary care Saunders/Elsevier, Cave EF (1963) 7 fracture of the Os Calcis-the problem in general. 8600 Rockville Pike Emerg Radiol. 2004 Apr;52(4):380-4 Orthopedics. Calcaneal Avulsion Fractures: An Often Forgotten Diagnosis. Careers. Objectives: These should be treated with immediate reduction, plantarflexion splinting, and close monitoring. government site. Patients/participants: 2022 Mar;23(3):196. doi: 10.3892/etm.2022.11119. Google Scholar, Chhabra N, Sherman SC, Szatkowski JP Tongue-type calcaneus fractures: a threat to skin. J Orthop Trauma 28(10):551563, Lu B, Liu P, Wang Y, Yuan JB, Tang XM, Wei D et al (2015) Minimally invasive manipulative reduction with poking k-wire fixation in the treatment of various types of calcaneal fractures. To define the pathoanatomy of the tongue-type calcaneus fracture and assess the appropriateness of percutaneous techniques in addressing all planes of deformity in this injury. They are often superiorly displaced. Epub 2016 Apr 27. De Boer AS, Van Lieshout EMM, Van 't Land F, Misselyn D, Schepers T, Den Hartog D, Verhofstad MHJ. The Bohler angle measures 9. 2008 Feb;26(2):254.e1-4. J Biomech 28(3):269279, Sangeorzan BJ, Ananthakrishnan D, Tencer AF (1995) Contact characteristics of the subtalar joint after a simulated calcaneus fracture. Bookshelf Percutaneous Cannulated Screw Fixation vs. Plating With Minimally Invasive Longitudinal Approach After Closed Reduction for Intra-Articular Tongue-Type Calcaneal Fractures: A Retrospective Cohort Study. A reduced Bhler angle is noted (see annotated image below). PubMed Emerg Radiol 23(4):357363, Golshani A, Zhu L, Cai C, Beckmann NM (2017) Incidence and association of CT findings of ankle tendon injuries in patients presenting with ankle and hindfoot fractures. Calcaneus Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports Disclaimer, National Library of Medicine Foot Ankle Orthop. -, Ann Plast Surg. Provided by the Springer Nature SharedIt content-sharing initiative, Over 10 million scientific documents at your fingertips, Not logged in Please enable it to take advantage of the complete set of features! et al. 6 A 19-year-old man after a fall from height. Joseph Schatzker. White EA, Skalski MR, Matcuk GR Jr, Heckmann N, Tomasian A, Gross JS, Patel DB. Minimally-invasive treatment of calcaneal fractures. eCollection 2022. J Orthop Case Rep. 2019;9(2):11-14. doi: 10.13107/jocr.2250-0685.1358. The .gov means its official. Intra-articular tongue-type fractures of the calcaneus: anatomy, injury patterns, and an approach to management. Federal government websites often end in .gov or .mil. Although they are often associated to high-energy injuries in younger individuals, this type of fracture can also occur due to minor trauma. We reviewed cross-sectional imaging and documented the presence of a varus/valgus (coronal plane) or adduction/abduction (axial plane) position of the tongue fragment in relation to the intact posterior facet, with greater than 10 degrees of angulation being diagnostic of displacement. official website and that any information you provide is encrypted Percutaneous Cannulated Screw Fixation vs. Plating With Minimally Invasive Longitudinal Approach After Closed Reduction for Intra-Articular Tongue-Type Calcaneal Fractures: A Retrospective Cohort Study. Federal government websites often end in .gov or .mil. sharing sensitive information, make sure youre on a federal Correspondence to Berberian W, Sood A, Karanfilian B, Najarian R, Lin S, Liporace F. J Bone Joint Surg Am. Taha T, Mahmoud K, Attia AK, Mekhaimar MM. Foot Ankle Surg 22(1):18, Keck School of Medicine, University of Southern California, Los Angeles, USA, Eric A. Intervention: MeSH 1998 Sep-Oct;12(7):469-73. doi: 10.1097/00005131-199809000-00007. 2013 Jun 5;95(11):995-1000. doi: 10.2106/JBJS.L.01498. Pathology Calcaneal fractures can be divided broadly into two types depending on whether there is articular involvement of the subtalar joint 2,7,8: extra-articular: 25-30% anterior calcaneal process fracture Would you like email updates of new search results? Careers. The normal value for Bohler's angle is 20-40. Ankle radiographs revealed a tongue-type calcaneal fracture. Imaging interpretation and clinical management of these fractures are discussed. Sanders R, Vaupel ZM, Erdogan M, Downes K. J Orthop Trauma. eCollection 2020 Jul. type 2c: involves one primary fracture line that courses through the medial aspect of the posterior facet and is accompanied by a transverse fracture through the body of the calcaneus; this fracture is often accompanied by one or more accessory fracture lines that do not involve the posterior articular facet 1992 Jun;158(6):1271-4 Conclusion: a Lateral radiograph shows a comminuted calcaneal fracture with a tongue-type component (arrow). Tongue-type fractures make up 25-35% of intra-articular calcaneal fractures [ 10, 11 ]. The tongue-type calcaneus fracture most often displaces into a position of plantarflexion, valgus, and adduction. This is a preview of subscription content, access via your institution. Before Federal government websites often end in .gov or .mil. Blisters associated with lower-extremity fracture: results of a prospective treatment protocol. and transmitted securely. Tongue-type calcaneal fractures represent 14% to 20% of all calcaneus fractures. J Orthop Trauma. HHS Vulnerability Disclosure, Help AJR Am J Roentgenol. Bookshelf The site is secure. sharing sensitive information, make sure youre on a federal Epub 2018 Jul 30. Injury. Recognition of the imaging findings, accurate interpretation, and timely communication may prevent devastating clinical outcomes including soft tissue coverage procedures and amputation. Fifty-six displaced Sanders 2B and 2C tongue-type calcaneus fractures identified from an initial cohort of 1118 calcaneus fractures treated over a 16-year period. Tongue Type Calcaneal Fracture - Discussion: - if secondary frx line travels parallel w/ plantar aspect of foot, exiting at posterior border of the calcaneus, tounge frx will develop; - secondary fracture line extends posteriorly from superior part of primary frx line (at crucial angle), creating 1 single posterior, superior, & lateral fragment; Calcaneal fractures account for 60% of all tarsal bone fractures. Google Scholar, Snoap T, Jaykel M, Williams C, Roberts J (2017) Calcaneus fractures: a possible musculoskeletal emergency. Strauss EJ, Petrucelli G, Bong M, Koval KJ, Egol KA. 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