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Year |
2001 |
|---|---|
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Question Number |
173. |
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Category |
Select |
Question
What portion of the calcaneus typically maintains a normal relationship to the talus in displaced intra-articular calcaneus fractures?
1- sustentaculum tali
2- tuberosity
3- anterolateral
4- posterior facet
5- lateral wall
Figures
Answer (click for answer)
Preferred response: 1
A predictable pattern of calcaneal fracture lines occur after axially loading. The primary fracture line extending obliquely from plantar-medial to dorsolateral is caused by the impact of the lateral process of the talus into the posterior facet of the calcaneus. This produces an anteromedial (sustentacular) and a posterolateral fragment. The sustentacular fragment may vary in size depending on the position of the primary fracture line through the posterior facet. This fragment can be essential for the surgeon attempting to restore subtalar joint congruity, since it usually maintains its position in relation to the talus via the presence of strong interosseous talocalcaneal ligaments. One common method of restoring continuity of the displaced intra-articular fragment is to place lag screws under fluoroscopic guidance from lateral to medial into the superomedial fragment.
Reference: Olexa TA, Ebraheim NA, Haman SP: The sustentaculum trail: Anatomic, radiographic, and surgical considerations. Foot Ankle Int 2000; 21: 400-4003.