A=initial encounter for closed fracture, B=initial encounter for open fracture, D=subsequent encounter for fracture with routine healing, G=subsequent encounter for fracture with delayed healing, K=subsequent encounter for fracture with nonunion, P=subsequent encounter for fracture with malunion, S=sequela
Calcaneus Avulsion Fracture ICD-9
Calcaneus Avulsion Fracture Etiology / Epidemiology / Natural History
Calcaneus Avulsion Fracture Anatomy
Transmits body weight to ground, strong lever arm for calf muscles
Main weight beaing surface is the posterior facet
Anterior process: a saddle-shaped projection of bone at the superior aspect of the calcaneal body. Its inferior surface articulates with the cuboid. The bifurcate ligament inserts on the anterior process and connects the cuboid and navicular bones. Serves as the origin of part of the extensor digitorum brevis.
Peripheral structures of the calcaneus include the sustentaculum tali, the peroneal tubercle, and the medial and lateral calcaneal tubercles.
Tibial nerve crossses the calcaneous below the sustentaculum tali medially and may be injured with displaced fractures causing incomplete loss of sensation on the plantar surface of the foot.
Calcaneus Avulsion Fracture Clinical Evaluation
Document smoking history, diabetes, PVD (increased risk of wound complications).
Document plantar foot sensation (risk of tibial nerve injury with incomplete loss of sensation on the plantar surface of the foot.)
A/P, Lateral, and Mortise Ankle and A/P, Oblique, Lateral foot xrays indicated.
Harris view(axial view): demonstrates degree of lateral migration of the tuberosity.
Broden's view-demonstrates articular surface of posterior facet-pt supine, cassette under leg/ankle, foot in neutral flexion with leg internally rotated 30-40, beam centered over lateral malleolus; xrays taken at 40, 30, 20, 10 degrees toward head of patient. Shows posterior facet as it moves from posterior to anterior. (Bruden Acta Radiol 31:85;1949). Generally get CT instead.
Bohlers angle(on lateral xray) usually between 20°-40°; formed by lines drawn from the highest point of the anterior process of the calcaneous to the highest point of the posterior facet and a line drawn tangential to the superior edge of the tuberosity. Decrease indicates posterior facet has collapsed.
Gissane's Angle(on lateral xray) seen directly inferior to the lateral process of the talus, formed by lines along lateral border of posterior facet and anteriorly to the beak of the calcaneous. Usually between 95° and 105°.