Fractures of the calcaneus occur with a frequency of 4% of all fractures. The mechanism of fracture is usually straightforward: a fall from a height on the heel or heel. There is a break-in the heel of the talus and calcaneus split. Quite often both at once broken heel bone. Depending on the height of the fall there are simple or fragmented and comminuted fractures, and the position of the foot during the stroke determines the direction of the fracture and displacement of bone fragments.
Fractures of the calcaneus may be intraarticular and extraarticular. For extra-articular fractures are fractures of the calcaneal tuberosity, which in turn are classified by type of fracture, "beak", detachments of the median tubercle of the calcaneus, vertical and horizontal fractures.
Extraarticular fractures are fractures and joint area between the calcaneus and cuboid bones. These include fractures of the type "parrot beak" and comminuted fractures of the field.
Intra-articular fractures are called fractures, the line that comes into the subtalar joint. They are divided into fractures and fractures with displacement without displacement. The patient complains of pain in the heel. Can change shape. The heel flattened, expanding its base. Edema, which usually extends into the Achilles tendon. Pain expressed by a sharp increase with palpation. Stepping on heels impossible because of severe pain, but movement in the ankle joint is preserved.
To clarify the diagnosis performed x-rays in three projections. The degree of severity of the fracture is judged by the corner of the calcaneal tuberosity. This angle is the angle of Böhler.
Treatment of fractures of the calcaneus. First of all, the fracture is held analgesia with local anesthetic solutions. If the bias on the X-rays has been detected on a leg plaster cast is applied from the toes to the knee, particular attention is given to the formation of the longitudinal arch of the foot.
The duration of immobilization for up to three months. Then the blindfold is removed and assigned physical therapy and physical therapy. Assign wearing orthopedic shoes with arch support for a period of not less than six months.
Fractures of the calcaneus with displacement treated by simultaneous reduction, if possible, with the imposition of a subsequent cast. Often it is necessary to use the internal fixation. At the same surgery performed in a delayed time, 1-2 weeks after the fracture. Fragmented and comminuted fractures treated with the Ilizarov fixator for 1.5-2 months.