Fractures of the anterior process of the calcaneum; a review and proposed treatment algorithm. Issue 3 (June 2019)

• Record Type: Journal Article
• Authors: Dhinsa, Baljinder S.; Latif, Ahmed; Walker, Roland; Abbasian, Ali; Back, Diane; Singh, Sam
• Is Part Of: Foot and ankle surgery. Volume 25:Issue 3(2019)
• Page Start: 258
• Page End: 263
• Publication Date: 2019-06
• Subjects: Fracture -- Calcaneum -- Anterior process -- Avulsion -- Compression -- Calcaneocuboid; Foot -- Surgery -- Periodicals; Ankle -- Surgery -- Periodicals; Ankle -- surgery -- Periodicals; Foot -- surgery -- Periodicals; Ankle -- Surgery; Foot -- Surgery; Periodicals; Electronic journals; 617.58
• DOI: 10.1016/j.fas.2018.02.004
• Languages: English
• ISSNs: 1268-7731

Abstract

Highlights: Delay in diagnosis is common and has a negative impact on outcome. High index of suspicion with an accurate history and examination. If plain radiographs are inconclusive, CT/MRI is required. Undisplaced/minimally displaced fractures managed initially non-operatively. Acute surgical intervention indicated for large type III fractures. Abstract: Background: There remains a lack of recognition of these fractures, which leads to a delay in diagnosis and appropriate management. Methods: A comprehensive literature search was performed. Following inclusion and exclusion criteria, 23 studies were available for analysis. Results: Delay in diagnosis is common and has a negative impact on outcome. If an APC fracture is suspected; anteroposterior, lateral and oblique plain radiographs should be requested. Further investigation with computed tomography or magnetic resonance imaging is indicated if plain radiographs are inconclusive and patient remains symptomatic. Non-operative measures are usually adequate for most undisplaced fractures, however surgical intervention maybe required for large, intra-articular fractures in the acute setting and for non-union. Conclusions: A treatment algorithm is suggested that may help with the diagnosis and management of these injuries. Level of evidence: Level IV.