Foot & Calcaneal Fractures: NEET PG Essentials
1. Calcaneal Fractures
- Mechanism: Axial loading (e.g., fall from a height).
- “Don Juan” Syndrome: Associated with lumbar spine (calcaneal + thoracolumbar) fractures. Always radiograph the spine if a calcaneal fracture is present.
- Bohler’s Angle: Normal is 25–40°. In calcaneal fractures, this angle decreases (often < 20°).
- Essex-Lopresti Classification: Based on the presence of a “tongue” or “joint depression” pattern.
2. Other Key Foot Fractures
| Fracture | High-Yield Clinical Detail |
|---|---|
| Jones Fracture | Fracture of the base of the 5th metatarsal (metaphyseal-diaphyseal junction). High risk of non-union. |
| Lisfranc Injury | Tarsometatarsal fracture-dislocation. Essential to check for “fleck sign” (avulsion at the base of the 2nd metatarsal). |
| Talus Fracture | “Aviator’s fracture” (neck of the talus). High risk of AVN due to retrograde blood supply. |
3. Examination & Management Pearls
- Sanders Classification: Used for intra-articular calcaneal fractures based on the number of fracture fragments in the posterior facet (as seen on coronal CT).
- Pseudojones Fracture: Avulsion fracture of the 5th metatarsal base (very common, usually heals with a boot). Do not confuse with the true Jones fracture.
- Lisfranc Instability: If widening between the 1st and 2nd metatarsal bases is seen on weight-bearing X-rays, it is considered unstable and requires surgery.
- Hawkins Classification: Used for talus neck fractures to predict the risk of AVN (Type I–IV).
- Compartment Syndrome of the Foot: A serious complication of high-energy midfoot injuries; requires high clinical suspicion.