FRACTURES OF THE CALCANEUS

¹ TORONTO, ONTARIO, CANADA

Compression fractures of the calcaneus are serious injuries, because of the frequent derangement of the upper articular facets. Because the interpretation of the broken fragments is difficult, a study was undertaken to determine the significance of the various lines seen in the lateral and plantar roentgenograms of the normal bone; with the knowledge acquired, recognition of the various forms of displacement in cases of fractures became easier. Inasmuch as the appearance of the bone differs greatly when the roentgenogram is taken with the foot in eversion or inversion, this fact had to be taken into consideration when assessing the findings. An imaginary line connecting the anterosuperior with the posterosuperior angle we have called the ceiling line. In eversion only one projection, the portion of the bone immediately behind the posterior facet, lies above this line; while in inversion the sustentaculum tali also rises above it. The fractures are reduced by a combination of simultaneous traction and compression. Reduction of the fracture is always done with the help of the fluoroscope, the plantar view being obtained by having the patient lie on his face with the feet projecting beyond the table. An excellent view can then be obtained by directing the rays from below. Fixation is by plaster for a month only. This is followed by exercises without weight-bearing for another month, after which weight-bearing, commencing with the use of crutches, is allowed.

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