Fractures of the anterior process of the calcaneum; a review and proposed treatment algorithm

Dhinsa, Baljinder; Latif, Ahmed; Walker, Roland; Abbasian, Ali; Back, Diane; Singh, Somendra Pal

doi:10.1016/j.fas.2018.02.004

Cited by 10 publications

(14 citation statements)

References 25 publications

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“…This localizes tenderness to the sinus tarsi or calcaneocuboid joint and can often be a distinct clinical finding to generalized lateral malleolar soft tissue pain seen in ankle sprains. Another examination finding may be tenderness to palpation at a point 2 cm anterior to the tip of the lateral malleolus (Figure 11) [1,7,8]. There is little evidence regarding the optimal management of these injuries in the literature, mainly limited to case reports and small sample observational trials.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…There is little evidence regarding the optimal management of these injuries in the literature, mainly limited to case reports and small sample observational trials. Almost all fractures that do not involve the Chopart joint line are treated non-operatively with good results [ 1 ]. A case series that described some injuries extending to the calcaneocuboid joint showed they tended not to unite with immobilisation alone, leading to ongoing symptoms necessitating surgical excision of bony fragments or delayed fixation [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…A case series that described some injuries extending to the calcaneocuboid joint showed they tended not to unite with immobilisation alone, leading to ongoing symptoms necessitating surgical excision of bony fragments or delayed fixation [ 7 ]. It has therefore been suggested that displaced or large acute fractures with calcaneocuboid joint involvement or displacement may be best managed with an open reduction and internal fixation [ 1 ]. A review of APC fracture management reported that a total of 17 fractures have been presented in the literature that underwent acute operative management.…”

Section: Discussionmentioning

confidence: 99%

“…Fractures of the anterior process of the calcaneus (APC) are considered rare injuries. The true incidence of APC fractures is hard to judge due to the high rates of misdiagnosis and delayed diagnosis, with reports suggesting the average delay in diagnosis to be 22 weeks [ 1 ]. In fact, up to 40% of cases may be misdiagnosed as a sprained ankle initially in accident and emergency departments and around 5% of patients with a history of an ankle sprain may have a fracture of the anterior process [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Open Reduction and Internal Fixation of a Calcaneal Anterior Process Fracture Using a Locking Plate

Cullen¹,

Khan²,

Park³

et al. 2021

Cureus

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Fractures involving the anterior process of the calcaneus (APC) are rare, underdiagnosed, and carry a significant increase in morbidity if not identified acutely. Identifying patients with intra-articular fracture extension is crucial as they may benefit from surgical fixation to reduce the risk of morbidity and posttraumatic osteoarthritis. There are no specific guidelines in the United Kingdom regarding the management of these fractures, and there is little evidence regarding optimal management, mainly limited to case reports and small sample observational trials. Previous reports of surgical intervention have described excision of fragments or fixation using single cancellous screws.A 55-year-old man fell from a height of 2 metres, sustaining an APC fracture extending into the calcaneocuboid joint. This was identified on plain radiographs following a virtual fracture clinic referral from the emergency department and further investigated with computed tomography scanning.He underwent open reduction and internal fixation with a locking T-plate and screws three weeks post-injury to restore congruence of his articular surface. Following a period of non-weight-bearing and progressive physiotherapy, he reported an excellent functional outcome six months post-operatively, measured by the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score of 90%.In the absence of specific guidelines for these fractures, this case provides an example of good initial functional outcomes following surgical fixation using a locking plate and screws, the first such fixation of an APC fracture described in the literature. This case can also be seen as a useful reminder of the need for an index of clinical suspicion for these injuries, given that up to 40% may be missed in the emergency department. While now fairly widespread, not all hospitals will have a virtual fracture clinic system in place, meaning emergency department practitioners must be wary of these injuries before discharging patients with suspicious histories and examination findings with no follow-up. Examination techniques that may help differentiate APC fractures from ankle sprains are discussed to provide clinicians with evidence to support a suspicion of these injuries in the emergency department.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Open Reduction and Internal Fixation of a Calcaneal Anterior Process Fracture Using a Locking Plate

Cullen¹,

Khan²,

Park³

et al. 2021

Cureus

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Frakturen des Processus anterior calcanei – häufig übersehene Verletzungen nach Sprunggelenkdistorsion

et al. 2018

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Fractures to the anterior process of the calcaneus (PAC) have long been considered rare injuries and have received little attention in clinical research. On the contrary, recent studies have reported a distinct higher incidence, especially following ankle sprains. Decisive reasons are that fractures of the PAC are regularly missed on plain radiographs and that a clinical differentiation from injuries to the lateral ankle ligaments is difficult. With the broad availability of cross-sectional imaging modalities fractures of the PAC are diagnosed more frequently and more reliably. The purpose of this review is to give an overview on the diagnostics, classification and treatment recommendations to this topic and discuss the studies available. To date no evidence-based recommendations are available for the treatment of fractures of the PAC. The few case reports and case series published, predominantly recommend conservative treatment; however, the treatment regimens vary considerably, ranging from immobilization in a lower leg cast (2-10 weeks) to early functional treatment with full weight-bearing. The surgical treatment by open reduction and internal fixation has been described primarily for large dislocated fractures. Surgical excision is considered mainly in cases of persistent pain or symptomatic non-union following non-operative treatment. For both, non-operative and operative treatment, the case reports and case series report satisfactory outcomes for the majority of patients. Nevertheless, comparative studies and patient-rated outcome measures are missing. Therefore, evidence-based recommendations cannot be given.

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Anatomical and biomechanical evaluation of the lateral calcaneo-cuboid and bifurcate ligaments

Baumbach¹,

Kistler²,

Gaube³

et al. 2022

Foot and Ankle Surgery

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Fractures of the anterior process of the calcaneum; a review and proposed treatment algorithm

Cited by 10 publications

References 25 publications

Open Reduction and Internal Fixation of a Calcaneal Anterior Process Fracture Using a Locking Plate

Open Reduction and Internal Fixation of a Calcaneal Anterior Process Fracture Using a Locking Plate

Frakturen des Processus anterior calcanei – häufig übersehene Verletzungen nach Sprunggelenkdistorsion

Anatomical and biomechanical evaluation of the lateral calcaneo-cuboid and bifurcate ligaments

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