Calcaneal Fractures

Bob Handley

2008

The heel bone

• What is it like?

• Where does it break?

• Can I mend it?

• Should I mend it?

Short bone or long bone?

abc

Aoccdrnig to rscheearch at Cmabrigde uinervtisy, it deosn't mttaer waht oredr the ltteers in a wrod are, the olny iprmoetnt tihng is taht the frist and lsat ltteres are at the rghit pclae. The rset can be a tatol mses and you can sitll raed it wouthit a porbelm. Tihs is bcuseae we do not raed ervey lteter by it slef but the wrod as a wlohe.

Assessing reduction

• Vision

• Image

• Feel

• Arthroscopy

• Post-operative CT

• Intra-operative CT

Primary fusion

Evidence or principle?

The opposite of faith is certainty

A case

• 59 yr old labourer

• Fall from ladder at work

• Intact skin , no NV deficit

• 2-pack-a day smoker, mild hypertension

• Isolated injury

Recovery phase

Functional phase

Degenerative phase

Evidence or principle?

Faith or certainty?

Factors for Factors for OperationOperation

• Fit

• Under 60 yrs old

• Bohler’s angle >0o

• Type II/III

Factors against Factors against OperationOperation

• Smoker , HT

• Over 29 yrs old

• Most of post facet intact

• Heavy duty work ? Secondary gain

Summary

• Work in three dimensions

• Surgery is therapeutic not exploratory

• Treat the whole bone

• Multiple reduction checks

• I treat on principle, tempered by evidence