Patient Presentations | Lecture Note - Edubirdie

University:
The University Of Western Ontario
Course:
Pathology 3500B | Human Pathology
Academic year:

2023
Views:

66

Pages:

3
Author:

Kyuwon J.

Patient presentations ● Age/Sex ○ 35 year old male ● Fell from 3m height landing on feet first ● Severe heel pain ● Swelling +cannot bear weight ● Ecchymosis on hindfoot Findings CT ● Sagittal layer ● Observations ○ Disruptions in calcaneus cortical outline ○ Fracture line in posterior subtalar joints ○ Bohler angle not normal ○ Multiple fragments (comminution) Clinical significance ● Calcaneus commonly fractured ● Trauma (falls, vehicle accidents) ● High risk on long term disability ○ Chronic pain + decrease in mobility Managements ● Immobilization and pain control ● Non- displaced ○ Conservative ■ Cast +non-weight bearings ■ 8-12 weeks ● Displaced ○ Open reduction ○ Internal fixation ○ ORIF ● Severe comminution ○ Subtalar fusion needed ● Left ○ Yellow lines ■ Boehler's angle in 20-40 degree ■ Reduced = fracture indicator ○ Red box ■ Fracture zone on the calcaneus ● Right ○ Red box ■ Posterior subtalar joint involvement ● Intraarticular extensions Classification system ● Rely on number of facture lines in posterior facets ○ Type 1 ■ Non-displaced ○ Type 2 ■ Partial fractures ○ Type 3 ■ 3 part fractures ○ Shows severity + prognosis ● Early compartments of foot ○ Wounds in complications ○ Subtalar arthritis + malunion ■ Chronic heel pain

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