1	Case Presentation March 2007 Bonnie Lin, DPM PGY-1 Saint Vincent Charity Hospital
2	CC: painful swollen left foot HPI: 38 y/o aaf fell off the stairs 12 + hr before presenting to the ER. Stated her foot turned inward and she landed sitting on her left foot. Was able to get up and walk back home. Pain progressed w/o relief from otc tylenol. C/o of 10 out 10 sharp pain upon WB. Unable to ambulate due to pain. Denies any other injuries. PMH: denies any medical conditions SxHx: C-section x 2 Meds: vitamins, Tylenol Allergies: morphine SocHx: denies tobacco, etoh & illicit drug abuse
3	Clinical Presentation
4	Physical Exam Vital Signs: stable and afebrile Gen: A&Ox3, NAD, obese Derm: no open wounds; no erythema; non-pitting edema of foot & ankle; no ecchymosis; skin temp warm to warm Vasc: DP & PT nonpalpable due to edema, triphasic doppler signals DP & PT, no digital hair Neuro: sensitive to light touch; loss of sharp-dull sensation to ankle; loss of proprioception digits fourth & fifth Msk: no digital rom due to pain, excurciating pain upon palpation and C-C jt; unable to assess aj, stj rom due to pain
5	Radiographic Presentation
6	Radiographic Presentation
7	Diagnosis Avulsion fracture of the anterior process of calcaneus Rowe type 1C Degan type 1
8	Mechanism of Injury Inversion and Plantarflexion of the foot resulting in tearing the bifurcate ligament and avulsion of the anterior process of the calcaneus
9	Calcaneus Fracture Classification Rowe Type 1A: fx of medial tuberosity Type 1B: fx of sustentaculum tali Type 1C: fx of anterior process Type 2A: fx of posterior beak w/o achilles involvement Type 2B: fx of posterior beak w/ achilles involvement Type 3: extra-articular body fx Type 4: intra-articular body fx w/o depression Type 5: intra-articular body fx w/ depression Degan Type 1: non-displaced fx of the anterior process tip Type 2: displaced fx of the anterior process not involving the articular surface Type 3: displaced fx of the anterior process involving the articular surface
10	Treatment Plan Jones Compression Splint WB as tolerated w/ crutches Ice and Elevation Pain meds RTC for continuous evaluation If pain persists, fractured fragment can be excised
11	Patient Update Patient was seen one week later. Decreased pain and swelling. Able to ambulate without much pain. Returned sensation to whole foot. Applied ace bandage and walking boot x 6 weeks, WB as tolerated. Subsequent follow up: gradual decrease in pain and swelling. Patient was able to return to regular shoegear and daily activity without disability. No surgical intervention needed at this time.
12	Reference Banks AS, Downey MS, Martin DE, Miller SJ. McGlamery’s Comprehensive Textbook of Foot and Ankle Surgery. Volume 2 Third edition 2001; 1819-63 Degan TJ, Morrey BF, Braum DP. Surgical excision for anterior-process fractures of the calcaneus. Journal of Bone Joint Surgery Am. 1982 Apr; 64(4): 519-24. Duddy RK, Donahue WE Jr, Cavolo DJ. Anterior calcaneal process fractures. Recognition and treatment. Journal of American Podiatry Association. 1984 Aug; 74(8): 398- 401 Hodge JC. Anterior process fracture or calcaneus secundaris: a case report. Journal of Emergency Medicine. 1999 Mar-Apr; 17(2): 305-9. Levine J, Kenin A, Spinner M. Non-union of a fracture of the anterior superior process of the calcaneus: a case report. Journal of Bone Joint Surgery Am. 1959 Jan;41-A(1): 178- 80. Renfrew DL, el-Khoury GY. Anterior process fractures of the calcaneus. Skeletal Radiology. 1985; 14(2): 121-5. Rosen HM, Kanat IO. Anterior process fracture of the calcaneus. Journal of Foot Ankle Surgery. 1993 Jul-Aug: 32(4): 424-9.
13	"That’s all folks." That’s all folks.