Fractured? No, Crushed

​"Doc, I broke my foot about three months ago and was in a boot. Tonight I was in a fight. When I went to kick, I twisted my foot. I can walk, but wanted to come in to get it checked out."​Simple. Straight-forward. X-ray ordered.My eyes were rapidly drawn to the two gaping fracture lines—one posteriorly in the calcaneal tuberosity and the other extending from the posterior facet through the subtalar joint to the plantar surface. Böhler's angle confirmed what can be seen intuitively: This calcaneus was crushed.​Böhler's angle is formed from two intersecting lines coming together at the apex of the posterior facet. The first line is drawn parallel to the superior aspect of the tubercle from the highest part on the posterior tubercle to the highest point of the posterior facet. The second line is drawn from the highest point on the posterior facet to the highest point on the calcaneus at the calcaneocuboid joint. A normal angle is between 20 and 40 degrees. An angle less than 20 degrees indicates disruption and collapse of the subtalar joint at the posterior facet.​How much is new? How much is old? How could he be walking on this? How badly is this calcaneus destroyed? The patient was sent to the donut of truth (the CT scanner), and his prior treating institution confirmed that he had been diagnosed with a calcaneal fracture three months before. Those records indicated that it had been in near anatomical alignment, that he had been sent home with a boot...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs