Presentation
Presented to ED following a 2m fall from a ladder. Patient complaining of left foot and heel pain.
Patient Data
Plain films show a comminuted fracture of the left calcaneus with a flattening of Bohler's angle.
Comminuted fracture of the calcaneus.
While the patient was waiting on the ward for surgery he mentioned a sore back.
A burst fracture of L1 was noted.
Before a CT was arranged a thorough neurological examination of the lower limbs was performed. Thankfully there was none.
There is burst fracture of the L1 vertebral body with retrolisthesis of a fracture fragment into the spinal canal. Total distance of retrolisthesis is 11mm. The bony fragment is seen within the thecal sac. There is a fracture of the left lamina and a fracture of the left transverse process of L1. There is also a fracture of the right transverse process of L1. In addition, there is a fracture of the left transverse process of L2.
This patient had been using crutches to get to the bathroom so was told to stay in bed! The patient was then transferred to a tertiary center for stabilization of the spinal injury and fixation of the calcaneus.
The patient made an uneventful recovery and has promised to stay off ladders in the future.
Case Discussion
Any patient who has sustained a fractured calcaneus, especially from a fall has a high risk of associated injuries that may be missed initially due to the distracting injury. A thorough and focused tertiary survey in the emergency room should aim to rule out other injuries in common areas. In particular the thoracolumbar spine. Any areas of tenderness should then be imaged appropriately.
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