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CT Scan: of Calcaneal Fracture

- Discussion:
    - demonstrates intra-articular extension of frx
    - degree of comminution of posterior facet;
    - calcaneocuboid joint;
    - impingement of lateral border of calcaneus on lateral malleolus and entrapment of tendons or nerves can be demonstrated;
           - latter is best seen with the soft-tissue window examination;

- Axial Images:
    - pt extends hips & knees, & second scout film is obtained for transverse CT scanning (90 deg to the coronal view and parallel to the long axis of the foot);
    - transverse plane views provide good visualization of talo-navicular & calcaneocuboid joints, anteroinferior aspect of the posterior facet, the sustentaculum tali, and the lateral calcaneal wall;
    - use axial images to help determine how much of the posterior facet remains attached to the sustentaculum tali;

- Coronal Images:
    - position pt w/ hip and knees flexed, w/ feet taped together;
    - lateral x-ray (scout film) is obtained & position is modified until coronal sections are perpendicular to posterior facet;
           - usually needs to be angled 30 deg;
    - coronal images are taken in 3 mm slices from posterior calcaneus to the navicular;
    - determine location of primary frx line, as being intra- or extra articular at the posterior articular facet;
    - useful in visualizing talocalcaneal facets, is usually performed w/ patient supine and the knees flexed;
    - Sander's Classification:
           - choose the coronal CT image that shows the posterior facet in widest profile;
           - mark two verticle lines to divide the posterior facet into three equal secitons; (hence: A-Lateral, B-Central, Medial-C);
           - the final line marks the verticle border of the sustentaculum;
           - fractures which lie in the medial zones will be more difficult to visualize and hence, will be more difficult to achieve primary repair;
           - type II fractures: two part;
           - type III fractures: three part fracture w/ depression of posterior facet;
           - type IV: Severely Comminuted


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