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Fractures of the Os Calcis: Diagnosis and Treatment

1926; Radiological Society of North America; Volume: 6; Issue: 3 Linguagem: Inglês

10.1148/6.3.228

1527-1315

H. R. Conn,

Musculoskeletal Disorders and Rehabilitation

THE calcaneum, or os calcis, enjoys the distinction of being more frequently fractured than any of the other tarsal bones, and even comparatively the lesion is not rare. Strauss states that it comprises 2 per cent of all fractures, while Cahill, in an analysis of seventy-two cases ranging in age from fourteen to seventy-three years, places the percentage at between two and four. It is commonly the result of direct violence induced by a fall in which the victim alights upon the feet. The superimposed body weight exerts a crushing force producing impactions occasionally, but more frequently explosive comminution. Rarely a separation of the attachment of the tendon Achilles results from muscular activity. Invariably the treatment presents difficulties which must be intelligently surmounted unless more or less incapacitating and permanent deformities are to result. Structurally, the os calcis, by reason of the absence of a shaft and because of its spheroidal shape, offers very evident restrictions to manipulation and immobilization. The anatomical relations are complex and any distortion is magnified in gravity by the importance of the reciprocal articulations. Further the ligamentous attachments are of negative value as fulcrums against which reduction may be facilitated or maintained, and in particular the most important attachment, that of the tendon Achilles, is generally a malevolent influence toward the exaggeration of the deformity. Magnuson quotes Cotton as stating that 90 per cent of the cases present a permanent partial disability, while he himself, writing from an extensive experience With the Illinois Industrial Board, asserts that all cases show an ultimate loss of function ranging from 35 to 75 per cent. Cotton and Henderson, in an analysis of seventy-five cases, published in 1916, conclude their report in this significant manner: "Conservative treatment gives incredibly bad results. We must do better than this; it must be possible." Previous Classifications Miscellaneous attempts have been made, notably by Cabot and Binnie, to classify the various types of fracture peculiar to the calcaneum. They divide the calcis by an imaginary vertical plane passing through the center of the astragalus and find the posterior portion to be subject to the following lesions: cases with one large heel fragment, cases with one small heel fragment (avulsion fracture), and cases with cracks and fissures without separation. That portion of the calcis lying anterior to the vertical plane comprises an individual second group and, lastly, Cabot and Binnie refer to severe crushing fractures of the whole bone.