[QxMD MEDLINE Link]. - Closed reduction and percutaneous pinning for comminuted intra-articular fractures of the calcaneus: Preliminary results. -prone position; - no attempt is made to reconstruction the articular surface; Mansoor AhmedBohlers angle 1) most superior aspect of the posterior facet (posterior articular surface) to the highest point of the anterior process 2) superior portion of the calcaneal tuberosity to most superior aspect of posterior facetGissanes angle 1) along the lateral border of the posterior facet 2) along the anterior process of the calcaneus. Schepers T, van Lieshout EM, Ginai AZ, Mulder PG, Heetveld MJ, Patka P. J Foot Ankle Surg. Chen J, Yang Z, Kong C, Wei S. Minimally invasive dual incision with mini plate internal fixation improves outcomes over 30months in 20 patients with Sanders type III calcaneal fractures. American Orthopaedic Foot and Ankle Society, Association of Graduates, United States Air Force Academy. - non op patients returned to work at 273 days vs ORIF patients who returned at av 171 days; 12. - Non operative treatment: Patients A total of 33 patients with a unilateral calcaneal fracture and a minimum follow-up of 13 months participated. Richards PJ, Bridgman S. Review of the radiology in randomised controlled trials in open reduction and internal fixation (ORIF) of displaced intraarticular calcaneal fractures. 12 (1):125-35. Prevalence of Peroneal Tendon Instability in Calcaneus Fractures: A Systematic Review and Meta-Analysis. 1993. If very symptomatic, use a SLC with initial NWB period until pain subsides. Sanders R. Intra-articular fractures of the calcaneus: present state of the art. Oper Orthop Traumatol. 1976 Aug. 217 (1298):294-8. - Compartment syndrome of the foot after intraarticular calcaneal fracture. 2018 Apr. 51 (3):325-338. [CDATA[ Rare injury caused by forced inversion of the foot. Outcomes according to the AOFAS score were excellent or good in 80% of cases. (3) 1. A complete blood count (CBC), blood. - tuberosity fragment tilts into varus and is pulled proximally by the Achilles tendon; Intra-articular fractures may be treated in a closed fashion but are more commonly treated with a combination of open reduction, ostectomy, osteotomy, internal fixation, and/or arthrodesis of the subtalar and calcaneocuboid joints. Essex-Lopresti classification: It is based on fracture lines using lateral radiographical images.. Joint depression type with a single vertical fracture line through the angle of Gissane separating the anterior and posterior portions of the calcaneus. 1) Parrot nose type CALCANEAL FRACTURES Signs & Symptoms: Acute pain, edema about heel, pain w/ compression/palpation, pain w/ STJ motion, fx blisters on skin, plantar medial&lateral ecchymosis (mondur's sign) Bohler's Angle: Measures sagittal plane relationship of talus and calcaneus - compare to contralateral side. However, the sinus tarsi approach has limited exposure to the lateral wall, which. If an intra-articular calcaneal fracture is seen, the images should be scrutinized for a lateral malleolar fleck sign (ankle), which raises the likelihood of peroneal tendon instability 10. Lee A. Grainger & Allison's Diagnostic Radiology Essentials E-Book. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Fractures of the calcaneus: open reduction and internal fixation from the medial side a 21-year prospective study. Causes of fractures include the following: Extra-articular injuries are more likely to occur with a sudden twisting force applied to the hindfoot than with other mechanisms. 4. Surgical experience as a decisive factor for the outcome of calcaneal fractures using locking compression plate: results of 3years. [QxMD MEDLINE Link]. Bridgman SA, Dunn KM, McBride DJ, Richards PJ. Subscribe to our e-mail newsletter to receive updates. - references: 1931. - compartment syndrome deep central compartment is involved most often in calcaneal frx; The OTA classification related statistically significant with the MFS (p = 0.006), AOFAS score (p = 0.013), FOA (p = 0.019), Rowe (p = 0.0027), and MFA score (p = 0.03). Core Radiology. Nondisplaced intra-articular fractures are generally treated in a closed fashion. [Full Text]. Emergency Radiology. - Treatment Options: 2007 Aug. 120 (2):459-66; discussion 467-9. Fracture blisters: clinical and pathological aspects. a) Without displacement Grala et al reported ontwo groups of patients who underwent operative treatment for articular fractures of the calcaneus, one (n = 23) treated by standard reconstruction and the other (n = 19) treated with a large bone distractor. Arch Orthop Trauma Surg. Fracture characterization is essential to guide the management of these injuries. [4] : Both of these describe the primary fracture line. [24] At 1 year, group 1 had a mean Maryland Foot Score (MFS) of 79 and an American Orthopaedic Foot and Ankle Society (AOFAS) score of 77.37, whereas group 2 had an MFS of 84.4 and and AOFAS score of 86.1. Am J Orthop Surg. [26] The Bhler angle, the Gissane angle, and the height and length of the calcaneus were increased after treatment. Calcaneal Fracture Classifications - Everything You Need To Know - Dr. Nabil Ebraheim - YouTube Dr. Ebraheim's educational animated video describes the classifications of calcaneal. Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug ReferenceDisclosure: Received salary from Medscape for employment. Sports Medicine document.write ("?zoneid=188"); 7 (5):417-27. Significant varus or valgus alignment. 2001 Oct. 32 (8):633-6. - contraindications to open reduction: Open injuries that have been reported have occurred in only 2% of cases. Relat. 1985;145(1):131-7. [22] Postoperatively, there were significant changes in articular stepoff of the posterior facet, medial-wall displacement, and the Bhler angle. Epub 2013 Oct 28. J Orthop Surg Res. Essex-Lopresti describedthe following twocalcaneus fracture subtypes 3. Fractures of the os calcis. Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Unable to load your collection due to an error, Unable to load your delegates due to an error. Robert A Probe, MD Associate Professor of Orthopedic Surgery, Texas A&M University Health Science Center; Chairman, Department of Orthopedic Surgery, Scott and White Clinic and Memorial Hospital Am J Surg. - spinal compression frx; Sustentaculum tali fractures are rarely seen as isolated injuries. [QxMD MEDLINE Link]. - early mobilization with protection from wt bearing is maintained until frx union occurs; Acta Biomed. Zhonghua Wai Ke Za Zhi. eCollection 2022 Nov-Dec. Allegra PR, Rivera S, Desai SS, Aiyer A, Kaplan J, Gross CE. Calcaneal fractures are the most common tarsal fracture and can occur in a variety of settings. -distraction screws:ex fix across thecalcaneal tuberosity, distal tibia, and/or cuboid and the talus; Materials and methods: For 152 patients (189 calcaneal fractures; average followup, 9.9 years), all fractures were classified in accordance with the Essex-Lopresti, OTA, Regazzoni, and Sanders classifications and matched with the following scores: AOFAS score, CNHF, FOA, MFS, Rowe, MFA, SF-36, and VAS. 4) With comminution from below Treatment is symptomatic with weight-bearing to tolerance, with crutches. - typically results from fall from height (see mechanism) 4) Horizontal 95 (4):555-76. A so-called "lover's Fracture" is an intra-articular fracture produced by an axial loading force typically produced by a leap from a height with person landing on heels (also called a "Don Juan" fracture) Why is it called a "Lover's fracture?". Results: 1992. Calcaneus fractures. The posterior facet is a major weightbearing surface, though the anterior and middle facets bear more weight per unit area. Vol 2: 2041-100. Severely comminuted intra-articular fractures may be treated with a combination of open reduction and internal fixation (ORIF) and arthrodesis of the subtalar joint. Data Trace is the publisher of 2) Centrolateral depression of joint [QxMD MEDLINE Link]. 2. Diabetes Please confirm that you would like to log out of Medscape. Percutaneous reduction and fixation of displaced intra-articular calcaneus fractures. - frx of contra-lateral foot; 2018 May-Jun. Concomitant calcaneal fracture (s) with spine trauma indicate a greater chance of incomplete injury or intact neurology possibly due to dispersion of force vectors. Zhong L, Xu Y, Wang Y, Liu Y, Huang Q. Rowe CR, Sakellarides H, Freeman P. Fractures of os calcis - a long-term follow-up study one hundred forty-six patients. Comparing different types of calcaneal fractures, associated treatment options, and outcome data is currently hampered by the lack of consensus regarding fracture classification. Schepers T, Vogels LM, Schipper IB, Patka P. Percutaneous reduction and fixation of intraarticular calcaneal fractures. - secondary frx line; Curr Rev Musculoskelet Med. (2006) ISBN: 9783540262275 -. Minimally Invasive Treatment of Displaced Intra-Articular Calcaneal Fractures. - sustentacular fragment (constant fragment) Abstract. CT is the modality of choice to evaluate calcaneal fracture. - displaces superiorly & laterally resulting in incongruity of posterior facet and widening & shortening of heel; - joint depression calcaneal fracture. The calcaneus hasfour articular facets, which allow it to articulate with the talus superiorly and the cuboid anteriorly. 10. Int Orthop. 'https://flow.aquaplatform.com/ajs.php':'http://flow.aquaplatform.com/ajs.php'); Treatment of open intra-articular calcaneal fractures: evaluation of a treatment protocol based on wound location and size. Robert A Probe, MD is a member of the following medical societies: American Medical Association, Texas Medical Association, AO Foundation, American Academy of Orthopaedic Surgeons, American Orthopaedic Foot and Ankle Society, Orthopaedic Trauma AssociationDisclosure: Received consulting fee from Stryker Orthopaedics for consulting. - threaded Steinman pin is inserted through the posterior inferior corner of the calcaneus, across posterior facet and into the talar body; Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. 1998 Aug. 107-24. J Bone Joint Surg Br. 3-16. [QxMD MEDLINE Link]. 25 (2):239-256. LINDSAY WR, DEWAR FP. [QxMD MEDLINE Link]. - Complications of Treatment, Current Concepts Review. b) With displacement - Fatigue Fractures of the Calcaneus Anatomy Wagstrom EA, Downes JM. Lines A and B separate the calcaneus into medial, central and lateral columns. - in the review by Tufescu TV andBuckley R, the authors conducted a prospective cohort study of 169 patientswhosustained intra-articular calcaneal fractures; Mann's Surgery of the Foot and Ankle. Surgeon experience Signs & symptoms Compartment syndrome - common!! Bethesda, MD 20894, Web Policies Bilateral calcaneus fractures sustained in motor vehicle collision. - primary frx line: - most of these involve the posterior facet (but can involve anterior and middle facets); Besch L, Waldschmidt JS, Daniels-Wredenhagen M, Varoga D, Mueller M, Hilgert RE, et al. You are being redirected to The mechanism of injury in calcaneus fractures typically involves a high-energy axial load applied to the heel, which drives the talus downward onto the calcaneus. Grala P, Twardosz W, Tondel W, Olewicz-Gawlik A, Hrycaj P. Large bone distractor for open reconstruction of articular fractures of the calcaneus. - anteromedial (sustentacular) frag is rarely comminuted but varies in size; Foot Ankle Int. - Calcaneal Frx in Children Schepers T, van Lieshout EM, Ginai AZ, Mulder PG, Heetveld MJ, Patka P. Calcaneal fracture classification: a comparative study. [QxMD MEDLINE Link]. - Intra-articular fractures of the calcaneum treated operatively or conservatively. 2002 Oct. 23 (10):906-16. The https:// ensures that you are connecting to the Orthop Clin North Am. Clin Orthop Relat Res. Matherne T, Tivorsak T, Monu J. Calcaneal Fractures: What the Surgeon Needs to Know. 1992. Unauthorized use of these marks is strictly prohibited. Please. Rowe Classification: Types I-III do not involve the subtalar joint. - may be indicated for patients with inadequate soft tissues (diabetics with frx blisters) where risk of dehissence is high; Type 2B Posterior beak fracture (achilles involvement) Because it is the type of fracture that could . 2009 Mar-Apr;48(2):156-62. doi: 10.1053/j.jfas.2008.11.006. {"url":"/signup-modal-props.json?lang=us"}, Radswiki T, Vadera S, Niknejad M, et al. 2) Various Because of distraction of fracture fragments, injury was treated with open reduction and internal fixation. 2010 Aug. 41 (8):804-9. -cannulated screw: inserted from latearal to medial into the sustentaculum tali; [QxMD MEDLINE Link]. 2015;205(5):1061-7. 2009 May-Jun. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. - smoking patient who is unwilling to immediately quit smoking; Zwipp H, Paa L, ilka L, Amlang M, Rammelt S, Pompach M. Introduction of a New Locking Nail for Treatment of Intraarticular Calcaneal Fractures. Calcaneal fractures are best assessed with a calcaneal series of radiographs, though are often identified on a lateral ankle radiograph if the presentation does not lead the requesting of calcaneal views specifically. The calcaneus is the most commonly fractured tarsal bone and accounts for about 2% of all fractures. [QxMD MEDLINE Link]. Open Fractures of the Calcaneus: Soft-Tissue Injury Determines Outcome. Neurology Disability associated with calcaneal fractures is significant, often resulting in permanent disability. [QxMD MEDLINE Link]. - tongue fracture Podiatrists Extensive intraarticular fractures of the foot. (2009) ISBN: 9781416022206 -, 8. Intra-articular fractures are often classified using the Sanders classificationsystem, which is one of the only systems that correlates well with patient outcome. 2008. LIVIN' ON THE MD EDGE: Drive, Chip, and Putt Your Way to Osteoarthritis Relief, Osteoporosis and Osteopenia: Latest Treatment Recommendations, Osteoporosis: A Bare-Bones Guide to Diagnosis and Treatment. Journals A prospective study, Intraarticular calcaneal fractures. - extra-articular - technique: - anteriorly frx may exit laterally, usually at angle of Gissane, but it can also involve the calcaneocuboid joint; This website also contains material copyrighted by 3rd parties. Clin Orthop Relat Res. Sanders RW, Rammelt S. Fractures of the calcaneus. Intra-articular Calcaneus Fractures: Current Concepts Review. 48 (2):156-62. 30 (3):e75-81. Note loss of Bhler angle. Calcaneal Fractures - Should We or Should We not Operate?. The calcaneus (os calcis) is the largest of the tarsal bones. 2010 Jan-Feb. 49 (1):8-15. Brunner A, Heeren N, Albrecht F, Hahn M, Ulmar B, Babst R. Foot Ankle Int. document.write ('&cb=' + m3_r); Foot Ankle Int. Federal government websites often end in .gov or .mil. Orthop. 60-75% of injuries are intra-articular fractures, no significant increase in infection rates, peak incidence in women in seventh decade of life, violent contaction of the triceps surae with forced dorsiflexion, strong concentric contaction of the triceps surae with knee in full extension, intrinsic tightness of the gastrocnemius and achilles tendon, peripheral neuropathy leading to decreased pain sensation and proprioception resulting in recurrent microtrauma, increased physical activity in the setting of relative energy deficiency, primary fracture line results from oblique shear and leads to the following, includes the sustentaculum tali and is stabilized by strong ligamentous and capsular attachments, dictate whether there is joint depression or tongue-type fracture, strong contraction of gastrocnemius-soleus with concomitant avulsion at its insertion site on calcaneus, more common in osteopenic/osteoporotic bone, inversion and plantar flexion of the foot cause avulsion of the bifurcate ligament, superolateral fragment contains the articular facets, superior articular surface contains three facets that articulate with the talus, the flexor hallucis longus tendon is medial to the posterior facet and inferior to the medial facet and can be injured with errant drills/screws that are too long, between the middle and posterior facets lies the, projects medially and supports the neck of talus, connects the dorsal aspect of the anterior process to the cuboid and navicular, calcaneal tuberosity (Achilles tendon avulsion), the primary fracture line runs obliquely through the posterior facet forming two fragments, the secondary fracture line runs in one of two planes, the axial plane beneath the facet exiting posteriorly in, when the superolateral fragment and posterior facet remain attached to the tuberosity posteriorly, behind the posterior facet in joint depression fractures, based on the number of articular fragments seen on the coronal CT image at the widest point of the posterior facet, One fracture line in the posterior facet (, Two fracture lines in the posterior facet (, based on fracture morphology of the calcaneus tuberosity, tenting, ecchymosis, or lack of skin blanching with tuberosity fractures, neccessitates urgent sugical reduction and fixation to avoid posterior heel skin necrosis, must be debrided and epithelialized prior to surgical intervention, lack of heel cord continuity in avulsion fractures, lack of posterior heel skin blanching with tenting fractures, assess for compartment syndrome secondary to swelling, presence of Langer's lines and skin wrinkles suggests skin is appropriate for surgical intervention, decreased ankle plantarflexion strength with avulsion fractures, assess for neuologic compromise due to swelling, severe peripheral vascular disease may preclude surgical treatment due to poor wound healing potential, useful for evaluation of intraoperative reduction of posterior facet, with ankle in neutral dorsiflexion and ~45 degrees internal rotation, take x-rays at 40, 30, 20, and 10 degrees cephalad from neutral, visualizes tuberosity fragment widening, shortening, and varus positioning, place the foot in maximal dorsiflexion and angle the x-ray beam 45 degrees, demonstrates lateral wall extrusion causing fibular impingement, indicates partial separation of facet from sustentaculum, angle between line from highest point of anterior process to highest point of posterior facet + line tangential to superior edge of tuberosity, represents collapse of the posterior facet, angle between line along lateral margin of posterior facet + line anterior to beak of calcaneus, demonstrates posterior and middle facet displacement, demonstrates calcaneocuboid joint involvement, used only to diagnose calcaneal stress fractures in the presence of normal radiographs and/or uncertain diagnosis, cast immobilization with nonweightbearing for 10 to 12 weeks, anterior process fracture involving <25% of calcaneocuboid joint, comorbidities that preclude good surgical outcome (smoker, diabetes, PVD), avoids the high wound complications seen with these fractures, minimally displaced tuberosity fractures (<1 cm of displacement) without threatened soft-tissue envelope in elderly patients with reduced function or physical capacity, begin early range of motion exercises once swelling allows, early reduction prevents skin sloughing and need for subsequent flap coverage, ideal in patients with sever peripheral vascular disease or severe soft-tissue compromise, lag screws from posterior superior tuberosity directed inferior and distal, require urgent reduction and fixation to avoid skin necrosis (disastrous consequence), open reduction allows for sufficient debridement of contaminated tissue, inability to participate in closed treatment, large extra-articular > 2 mm displacement, posterior facet displacement >2 to 3 mm, flattening of Bohler angle, or varus malalignment of the tuberosity, anterior process fracture with >25% involvement of calcaneocuboid joint, wait 10-14 days until swelling and blisters resolve and wrinkle sign present 10-14 days, no benefit to early surgery due to significant soft tissue swelling, displaced tuberosity fractures with posterior skin compromise should be addressed urgently, number of intra-articular fragments and the, surgical treatment decreases the risk of post-traumatic arthritis, age > 50 (similar outcomes with surgical and nonsurgical treatment), initial Bhler's angle <0 (these injuries do poorly regardless of treatment), lower Bhler angles suggest greater energy absorbed, open fractures (significant soft tissue injury and engery absorbed), bilateral calcaneal fractures (significant gait problems following bilateral injuries), factors associated with most likely need for a secondary subtalar fusion, male worker's compensation patient who participates in heavy labor work with an initial Bhler angle less than 0 degrees, standard short-leg cast for calcaneal stress fractures, standard short-leg cast applied with mild equinus, windowed over posterior heel to allow for frequent skin checks, requires close follow-up to determine if pull of gastrocnemius-soleus dispaces fracture, weekly cast changes are necessary due to high incidence of skin complications, high incidence of vascular insufficiency and diabetes in this population, ideal for poor soft tissue coverage or patients with peripheral vascular disease, Steinmann pin placed into the fracture site anteromedially-to-posterolateral to leverage fragments into place, additional K-wires and Steinmann pins are placed from posterior-to-anterior and lateral-to-medial to secure remaining bone fragments, calcaneal transfixin pin can be used to distract fracture, percutaneus tamps and elevators can be used to raise the articular surface, pins are cut flush with the skin and removed 8-10 weeks post-op, can be combined with distracting external fixator, pins placed in calcaneal tuberosity, cuboid, and distal tibia, restor calcaneal height, width, and alignment, can be combined with percutaneous cannulated screws, extensile lateral L-shaped incision is most popular, vertical portion inbetween posterio fibula and achilles tendon, horizontal portion in line with 5th metatarsal base, a more inferior incision protects the sural nerve, provides access to the calcaneocuboid and subtalar joints, full-thickness skin, soft tissue, and periosteal flaps are developed, lateral calcaneal branch of peroneal artery, superior flap contains the calcaneofibular ligaments and peroneal tendon sheath, sural nerve and peroneal tendons are retracted superiorly, fracture opened and medial wall reduced going medial to lateral, reduction confirmed indirectly via fluoroscopy, tuberosity reduction is done under direct visualization, manual traction, Schanz pins, and minidistractors, height and length of tuberosity is recreated, definitive fixation with plates and screws, restore Bhler's angle and calcaneal height, minimally invasive incision that minimizes soft tissue dissesction, reduces wound complications associated with extensile lateral incision, allows direct visualization of the posterior facet, anterolateral fragment, and lateral wall, same incision can be utilized for secondary subtalar arthrodesis or peroneal tendon debridement, patient placed in lateral decubitus position, incision made in line with the tip of the fibula and the base of the 4th metatarsal, extensor digitorum brevis retracted cephalad to expose sinus tarsi and posterior facet, Schanz pin inserted percutaneously in posteroinferior tuberosity going from lateral to medial, provides distraction and aids with reduction, fibrous debris and fat removed from sinus tarsi, small elevator or lamina spreader placed under posterior facet fragment to aid in reduction, K-wires inserted for provisional fixation aimed towards the sustentaculum, two screw are placed lateral-to-medial to engage sustentaculum and support facet, one large fully threaded screw from posterior-to-anterior to support axial length of calcaneus, low-profile plate is applied underneath a well developed soft tissue envelope with screws engaging anterolateral and tuberosity fragments, nonweight bearing for 6-8 weeks post-op with ankle range-of-motion exercises beginning 2 weeks post-op, manipulate the heel to increase the calcaneal varus deformity, manipulate the heel to correct the varus deformity with a valgus reduction, stabilize the reduction with percutaneous K-wires or open fixation as described above, arthroscopic-assisted reduction and internal fixation, improved visualization of articular surface and carilage lesions, increased swelling from fluid extravasation, can be combined with sinus tarsi approach, patient positioned in lateral decubitus position, fluoroscopy unit positioned posterior and oblique to patient, anterolateral and posterolateral portals are used to visualize posterior facet, loose bodies and cartilage fragments are removed with a shaver, Freer elevator is introduced into one of the portal sites and used to elevate the posterior facet, Schanz pin to control tuberosity fragment, cannulated screws from the posterior aspect of the calcaneal tuberosity to the anterior aspect of the calcaneus, lateral-to-medial screws placed in sustentaculum, buttress screw from the posterior aspect of the calcaneal tuberosity to the subchondral bone of the posterior facet, posterior approach for calcaneal tuberosity fractures, fracture fragment is mobilized and debrided, plantar flexion of foot aids with reduction, presence of gastrocnemius tightness may preclude reduction, Strayer procedure may be performed to aid in reduction, figure-of-8 tension-band wire passed around ends of K-wires or cannulated screws, Krackow sutures passing through bone tunnels, restricted weight bearing for 6 weeks followed by progression of weight bearing an additional 6 weeks, performed in highly comminuted Sanders IV intraarticular fractures, high rate of secondary fusion after ORIF with these injuries, avoids added treatment costs and decreases time off from work, can be performed through an extensile lateral or sinus tarsi approach, fracture reduction is perfromed in a similar fashion as ORIF, articular cartilage of the subtalar joint denuded to bleeding subchondral bone, cannulated compression screws are placed from the posterio calcaneal tuberosity to the talar dome, lateral fixation plate applied to hold reduction, increased risk in smokers, diabetics, and open injuries, may consider nonoperative treatment in these patients, tongue type fractures at high risk (>20%) for posterior skin necrosis, should be splinted in 30 degrees of planarflexion to relieve soft tissue tension, keep all hardware away from the corner of the incision, delayed wound healing is the most common complication, can be addressed with ankle bracing (gauntlet type), NSAIDs, injections, and physical therapy, may require bone block subtalar arthrodesis to address loss of calcaneal height, important when there are symptoms of anterior ankle impingement, Lateral impingement with peroneal irritation, at risk with placement of lateral to medial screws, especially at level of sustentaculum tali (constant fragment), loss of height, widening, and lateral impingement, distraction bone block subtalar arthrodesis, incongruous subtalar joint/post-traumatic DJD, results from posterior talar collapse into the posterior calcaneus, Lateral exostosis with no subtalar arthritis, Lateral exostosis with subtalar arthritis, Lateral exostosis, subtalar arthritis, and varus malunion, increased due to mechanism (fall from height), smoking, and early surgery, lateral soft tissue trauma increases the rate of complication, Proximal Humerus Fracture Nonunion and Malunion, Distal Radial Ulnar Joint (DRUJ) Injuries.

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