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PubMed1992

[Pathomechanical aspects of intra-articular calcaneus fractures. Typing, grading and surgical therapy].

The forces to produce fractures of the os calcis are combined compression and shear under a cranio-caudal impulse of 10-40 kN and a short time of stroke about 10-40 ms. The main patterns in biomechanics of calcaneal fractures are the time of stroke and the geometrical position of the foot in the moment of impact. Furthermore individual structural changes of the calcaneal cancellous bone, age, diseases as Diabetes mellitus and vascular obliterations are to be respected. Operative treatment of these fractures needs an understanding of the pathomechanism of the intracalcaneal shear-tension-forces. With plantarflexion of the foot combined with vertical forces within 40 ms to the anterior talocalcanear facette impact-fractures of the anterior part can be expected. These forces develop a posterior directed shear tension parallel to the axis of the os calcis, dividing the bone horizontally in two parts (Typ A, 44-56%), well-known as tongue-type fracture. Compression of the posterior talo-calcaneal joint leads to an impact of this structure producing the joint depression type within about 30 ms in dorsoflexion of the foot (Type B, 42%) together with sagittal shear fractures. High-energy forces are supposed to produce the so-called primary fractures of the sustentacular process in about 10 ms in a supinated position of the foot (Type C, 2-10%); these fractures represent in cases of dislocation an indication for open reduction and internal fixation. In our own experience with 45 cases in 35 patients using the lateral or/and medial approach no infection happened. Palmer's lateral approach was preferred.

Biomechanical Phenomena↗
PubMed1992

[Mechanism of articular fracture of the calcaneus in experimental, pathological, roentgenographic and computerized tomography examination].

The experiments on amputated extremities, pathological examination as well as plain and computerized radiology confirmed existence of two basic types of calcaneal articular fractures: tongue type and crush type. An accurate anatomy of the experimentally fractured os calcis could be restored only after Westhues. An articular surface in crush fracture could be restored only in open arthrotomy. Computerized tomography revealed the type of the fracture and the degree of calcaneal destruction very precisely but was of no practical value in the treatment of the os calcis fractures.

Amputation, Surgical↗