Calcaneus (Heel Bone) Fractures
Article by Dr. Darren R Keiser MD
Fractures of the heel bone, or calcaneus, can be disabling injuries. They most often occur during high-energy collisions — such as a fall from height or a motor vehicle crash. Because of this, calcaneus fractures are often severe and may result in long-term problems. The calcaneus is the most frequently fractured tarsal bone. Tarsal bone fractures account for about 2% of all adult fractures. Of these, 60% are calcaneus fractures.
The heel bone is often injured in a high-energy collision where other parts of the skeleton are also injured. In up to 10% of cases, the patient can also sustain a fracture of the spine, hip, or the other calcaneus. Injuries to the calcaneus often damage the subtalar joint and cause the joint to become stiff. This makes it difficult to walk on uneven ground or slanted surfaces.
The severity of a fracture usually depends on the amount of force that caused the break. There are many types of calcaneus fractures, including:
Stable fracture. This type of fracture is nondisplaced. The broken ends of the bones meet up correctly and are aligned. In a stable fracture, the bones usually stay in place during healing.
Displaced fracture. When a bone breaks and is displaced, the broken ends are separated and do not line up. This type of fracture often requires surgery to put the pieces back together.
Open fracture. Broken bones that break through the skin are called open, or compound. These types of injuries often involve much more damage to the surrounding muscles, tendons, and ligaments. Open fractures have a higher risk for complications and take a longer time to heal.
Closed fracture. With this injury, the broken bones do not break the skin. Although the skin is not broken, internal soft tissues can still be badly damaged.
Comminuted fracture. This type of break is very unstable. The bone shatters into three or more pieces.
The calcaneus can be injured in a fall, twisting injury, or motor vehicle collision. A simple twisting injury may result in the calcaneus being cracked. The force of a head-on car collision may result in the bone being shattered (comminuted fracture).
Different causes can result in similar fracture patterns. For example, when landing on your feet from a fall, your body’s weight is directed downward. It drives the talus bone down into the calcaneus. In a motor vehicle crash, the calcaneus is driven up against the talus. In both cases, the resulting fracture patterns are similar. The greater the impact, the more the calcaneus is damaged.
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Article URL: http://orthoinfo.aaos.org/topic.cfm?topic=A00524