A 35-year-old man presents after jumping from a 3-story...

A 35-year-old man presents after jumping from a 3-story building in a suicide attempt. He is unconscious on arrival and immediately intubated. His feet are swollen and appear deformed, and radiographs are obtained to rule out calcaneal fractures. Which of the following is TRUE regarding calcaneal injuries? (A) Boehler's angle measured at 10 degrees rules out the possibility of occult fracture. (B) Management is primarily supportive care, and surgery is rarely necessary. (C) Associated vertebral fractures are classic but not commonly found. (D) The patient is at risk for developing a compartment syndrome.

A 35-year-old man presents after jumping from a 3-story building in a suicide attempt. He is unconscious on arrival and immediately intubated. His feet are swollen and appear deformed, and radiographs are obtained to rule out calcaneal fractures. Which of the following is TRUE regarding calcaneal injuries?
(A) Boehler's angle measured at 10 degrees rules out the possibility of occult fracture.
(B) Management is primarily supportive care, and surgery is rarely necessary.
(C) Associated vertebral fractures are classic but not commonly found.
(D) The patient is at risk for developing a compartment syndrome.

Key Concepts

Calcaneal Fracture

Calcaneal fractures are breaks in the heel bone that often occur due to high-energy axial load injuries, such as falls from a height. They can be complex injuries that may involve displacement and depression of the articular surface, potentially leading to long-term complications if not managed appropriately.

Boehler's Angle

Boehler's angle is a radiographic measurement used on lateral foot x-rays to assess the integrity of the calcaneus. A normal angle ranges between approximately 20 to 40 degrees; a decreased angle may indicate a fracture with collapse of the calcaneal structure, aiding in both diagnosis and treatment planning.

Axial Load Injuries

Axial load injuries occur when a force is transmitted along the long axis of a bone, as seen in falls from heights or motor vehicle collisions. These injuries commonly result in fractures of the calcaneus and may concurrently injure other structures that absorb and transmit the load.

Compartment Syndrome

Compartment syndrome is a critical condition that can develop when increased pressure within a closed fascial compartment impairs circulation, potentially causing tissue ischemia and necrosis. In the context of calcaneal fractures and other high-energy lower extremity injuries, the risk of developing compartment syndrome is an important consideration.

Associated Spinal Fractures

Associated spinal fractures, particularly in the lumbar region, may occur concurrently with calcaneal fractures due to the high-energy axial loading forces involved in the injury. Recognizing this potential association is important in the comprehensive assessment and management of patients with such traumatic injuries.

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