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Fractures of the Os Calcis

1908; Massachusetts Medical Society; Volume: 159; Issue: 18 Linguagem: Inglês

10.1056/nejm190810291591801

2331-4710

Frédéric Cotton, Louis T. Wilson,

Management of metastatic bone disease

Our attention was first calletl to fractures of the os calcis by the frequency of permanent dis- ability, or of disability that threatened to be permanent, in cases which were seen in the sur- gical out-patient department of the City Hos- pital.It was only after seeing a considerable number of these cases that it occurred to us to observe them especially, or to treat them in any other than the routine way, which is to accept the result as inevitable.All the teachings of school and hospital, and all the data of the litera- ture, warn us that we should bo veiy careful to treat fractures of the os calcis by fixation and by putting them up in plantar flexion, so as to de- crease the tension through the tendo achillis, which may contribute to further displacement of the fractured heel.Considering that further displacement of.thefractured heel is impossible in the average fracture of this sort, at least unless the impaction has previously been reduced, this advice is about as practical as much that stands in the textbooks.Such treatment of fractures of the os calcis is perfectly respectable doctrine for a date ten or fifteen years ago, but is not, as we shall attempt to show, what should be expected to-day.There are, in the recent literature, several articles that seem to show an understanding of the lesions and the relative freeiuency and severity of these cases.All the articles are ad- mirable in their way.1Exhaustive as these articles are, none of them have anything to oiTer in regard to what seem to us the really important points, -the recognition and proper treatment of fresh cases.Treatment of deformity already produced by neglect does great good, but does not justify the neglect.Up to the time when good x-rays could be obtained, there was no definite way of estimating the extent of the lesion in these cases, and in many cases it was apparently impossible even to make a diagnosis with accuracy.The general assump- tion in these cases was that there was a breaking across of the os calcis.It was known that com- plicated crushing of the os calcis might, in fact, occur, and this was shown in museum specimens, out that such was the condition in the average case seems never to have been assumed.In this, as in other fracture findings, museum specimens Were discounted on the assumption that all the "'sions in a case of fatal injury were more severe than in cases ordinarily met with that recovered.