Minimally displaced but slightly comminuted fracture of the anterior process calcaneus (arrows) with considerable overlying soft tissue swelling involving the subcutaneous tissues and bifurcate ligament. Petrover D., Schweitzer M., Laredo J. Axial CT slice through the distal tibia shows a characteristic fracture pattern, with anterior, posterior, and medial major fragments, and central comminution. Anterior process fracture of the calcaneus. [Context Link], Hatch R., Dean C. (2015). Injury. The anterior process is a promontory of the calcaneus that forms the calcaneo-cuboid joint. The larger side surface of the acromion bone is curved and spreads towards the back, up and sideways. sharing sensitive information, make sure youre on a federal Partial tear of anterior talofibular ligament. This revealed an anterior process fracture of the calcaneus (see Figure 1) as well as widening of the medial clear space, consistent with ligamentous injury (see Figure 2). Minimally displaced but slightly comminuted fracture of the anterior process calcaneus (arrows)with considerable overlying soft tissue swelling involving the subcutaneous tissues and bifurcate ligament. The following can help manage your symptoms: Copyright Merative 2022 Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. ADVERTISEMENT: Supporters see fewer/no ads, Painful right foot following a twisting (inversion) injury. Tap on the below button when you are Online. fracture of spinousp process of C6, fracture of left transverse process C7 The patient was diagnosed with mild head injury, spinal cord injury due to . Injuries of the Distal Tibia and Fibula 2014 Oct;28(10):551-63. doi: 10.1097/BOT.0000000000000169. 56% of the fractures were non-displaced and 82% comminuted. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. One must give consideration to associated ligamentous injuries, especially injury to the anterior talofibular ligament, as this is commonly the case with fractures of the calcaneus (Petrover, Schweitzer, & Laredo, 2007). Over the next 3 months, her symptoms gradually improved and she was able to regain function at a reported level of 85%. Symptoms generally depend on the severity of the fracture but usually include significant pain, swelling, bruising, numbness, limited mobility, and limping, among others. Non-contrast head CT scan revealed soft tissue swelling at right temporoparietooccipital with no bone discontinuity, sulci . This is the 28th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Would you like email updates of new search results? Moderate pain and swelling with Ecchymosis present. It represents an avulsion fracture of the bifurcate ligament. Incidence and MR imaging features of fractures of the anterior process of calcaneus in a consecutive patient population with ankle and foot symptoms. [Context Link], Roosen H., Kanat I. 78% of the patients suffered concomitant injuries of the Chopart joint line. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Wheeless' Textbook of Orthopaedics. Anterior process of the calcaneus; Calcaneocuboid joint; Calcaneus; Fracture; Nonoperative treatment; Outcome. The .gov means its official. PMC In fractures with severe swelling . After conservative treatment failed, drilling of the fracture site was required to facilitate healing. When the radius breaks near the wrist, it is called a distal radius fracture. The fluid collection under the anterior fat pad has been referred to as the "teardrop" sign [ 2 ]. Inclusion criteria included patients with evidence of fractures of the anterior process of calcaneus on radiographs, MR images, or both; a time interval of up to 8 weeks between radiography and MRI; and imaging within 2 months of acute ankle injury. anterior cord compression on magnetic . Such fractures are often caused by direct trauma or falls from a peak, or happen as a outcome of sacral insufficiency secondary to osteopenia, persistent steroid use, or earlier pelvic irradiation. When this occurs, the heel can widen, shorten, and become deformed. Yet, a prolonged return to sports was noted. . Calcaneus fractures usually hurt and get very swollen right after the injury. A spinous process fracture is a break or crack in the back part of a vertebra. Tell him or her how the injury happened. Surgical excision for anterior-process fractures of the calcaneus. . Please enable it to take advantage of the complete set of features! A 17 year-old female presents with three months of anterior ankle pain. The patient was instructed on conservative management (rest, icing, compression, elevation) and started physical therapy the next week. Medically reviewed by Drugs.com. We present a case of a 14-year-old female basketball player who suffered a stress fracture of the anterior process of the calcaneus that was not associated with a calcaneonavicular coalition. If not treated by immobilization or fixation they can produce long term foot pain due to non-union. Sometimes the patient may be able to localise this pain to the inner or outer side of the ankle. Terms & Conditions Privacy Policy Disclaimer -- v08.06.00, Fostering a Safe and Healthy Work Environment through Competency-Informed Staffing, Psychological Safety and Learner Engagement: A Conversation with Dr. Kate Morse, Innovation and Solutions to Challenges in Nursing Education, Clinical Reasoning and Clinical Judgement: A Conversation with Lisa Gonzalez, Virtual Experiences and Clinical Judgement: A Conversation with Dr. Leila Casteel, COVID-19 2022 Update: The Nursing Workforce, Improving Outcomes by Caring for Communities, Meeting Students Where They Are: An Interview with Dr. Andrea Dozier, Lippincott NursingCenters Career Advisor, Lippincott NursingCenters Critical Care Insider, Continuing Education Bundle for Nurse Educators, Recognizing and Managing Adult Viral Infections, Developing Critical Thinking Skills and Fostering Clinical Judgement, Establishing Yourself as a Professional and Developing Leadership Skills, Facing Ethical Challenges with Strength and Compassion, Wheeless' Textbook of Orthopaedics (2012), http://www.uptodate.com/contents/calcaneus-fractures, http://www.wheelessonline.com/ortho/frx_of_the_anterior_calcaneal_process. Signs and symptoms depend on where the fracture happened and how severe it is: Your healthcare provider will examine you and ask about your symptoms. [Context Link]. . It can also happen in a car accident, a bike accident, a skiing accident or another sports activity. Twelve patients were women and 3 were men. Moderate swelling of the ankle. Epub 2009 Feb 20. Retrieved from http://www.uptodate.com/contents/calcaneus-fractures[Context Link], Judd D., Kim D. (2002). Anterior decompression and stabilization trally mediated analgesia may also be achieved by addi-by replacement of the affected vertebral bodies with . Given this, as well as noted ligamentous laxity on examination, a magnetic resonance imaging (MRI) of the ankle was obtained. Acute refers to swelling that occurs within 24 hours of injury. Results: There were 15 fractures of the anterior calcaneal process with an incidence of 1%. 2, 3, 4, 5 By continuing to browse the site you are agreeing to our use of cookies. Lateral wall: Irregularly flat' cortical surface with peroneal tendon tubercle at risk for lateral displacement and resulting subfibular impingement pain. Before A fracture of the APC is thought to occur from one of two mechanisms. Anterior calcaneal process fractures are the result of an inversion and plantarflexion injury. Anterior process fracture involving <25% of calcaneocuboid joint Comorbidities that preclude good surgical outcome (smoker, diabetes, PVD) All other fractures require surgical intervention Prognosis: Relatively poor with overall 40% complication rate (malunion, subtalar arthritis, clawing of toes) Take Home Points . 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. They're usually caused by traumas like falls or car accidents. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. . Tenderness to palpation anterior and inferior to the lateral malleolus (area of sinus tarsi) that is a common finding with anterior process fractures (Wheeless, 2012). Anterior Process Calcaneus fractures occur from an inversion injury to the ankle The bifurcate ligament pulls on the anterior aspect of the calcaneum resulting in a fragment of bone being pulled away Diagnosing the Anterior Process of the Calcaneum fracture X-ray and ultrasound examination can show an anterior process of the calcaneum fracture. Cibura C, Llsdorff R, Ramczykowski T, Schildhauer TA, Kruppa C. BMC Musculoskelet Disord. Anterior calcaneal process fractures are the result of an inversion and plantarflexion injury. The break usually happens due to falling on an outstretched or flexed hand. Both nonoperative and operative methods have been described, with varying outcomes. Figure 2. An occasional patient can stay calm during this process, but if the swelling is important or the digit has been traumatized, anesthesia is . No injury as such , took xray ,no fracture, difficulty in walking. Author(s), Article title, Publication (year), DOI. The calcaneus is the most commonly fractured tarsal bone, representing 60% of all tarsal fractures in adults (Hatch & Dean, 2015). . These fractures can occur in many different situations, but most commonly occur in high-energy trauma situations such as car crashes or falls from heights (ex. [Context Link], Wheeless C. (2012). 2022 Oct 28;23(1):942. doi: 10.1186/s12891-022-05903-8. The avulsed fragment's vertical dimension equals or exceeds its transverse dimension, and focal and minimal prevertebral soft-tissue swelling usually is present. In fractures with severe swelling . When taking the vertebral fractures in to account, the prevalence of osteoporosis even elevated to 51% [11]. Already a member? Appointments 216.444.2606 the patient may present with additional findings of redness, swelling, and obvious periosteal reaction at the site of stress fracture. FOIA which originate from the anterior . The aim of this study was to specify treatment algorithms through a modification of the Degan classification. Methods: Between 2009 and 2019, patients with APC fractures were retrospectively analyzed. Please wait while the data is being loaded.. Visit https://www.ajronline.org/pairdevice on your desktop computer. Calcaneus Fractures - Trauma - Orthobullets orthoBULLETS MBBULLETSStep 1For 1st and 2nd Year Med Students MBBULLETSStep 2 & 3For 3rd and 4th Year Med Students ORTHOBULLETSOrthopaedic Surgeons & Providers JOIN NOWLOGIN Home Topics Techniques Cards QBank Evidence Cases Videos Podcasts Groups Products Trauma Spine Shoulder & Elbow Knee & Sports Instructions were also given on rest, elevation, and icing to better manage associated pain and swelling. Sanders R, Vaupel ZM, Erdogan M, Downes K. J Orthop Trauma. You may also need any of the following: The fracture may take weeks or months to heal. Wagner, et al. An anterior process fracture can also occur as a concomitant injury with a fracture-dislocation through the midtarsal joint, typically associated with a more severe mechanism of injury. The part of the radius connected to the wrist joint is called the distal radius. Trnka HJ, Zettl R, Ritschl P. Fracture of the anterior superior process of the calcaneus: an often misdiagnosed fracture. She had been wearing a neoprene ankle support with minimal relief and reported feeling as though this support actually made the swelling worse. De Groot R, Frima AJ, Schepers T, Roerdink WH. (2007). Our goal is to generate more She was restricted to sedentary duty at work. Although these articles do not have all bibliographic details available yet, they can be cited using the year of online publication and the DOI as follows: Please consult the journal's reference style for the exact appearance of these elements, abbreviation of journal names, and use of punctuation. The acromion arches over the glenohumeral joint and articulates with the clavicle (collarbone) to form the acromioclavicular joint. This site uses cookies. Median RTW was 14 days (IQR 10-42), and RTS 90 days (IQR 30-180). Sign in, January/February 2016, Volume :35 Number 1 , page 45 - 47 [Free], Join NursingCenter to get uninterrupted access to this Article. Epidemiology Fractures of the anterior process of the calcaneum; a review and proposed treatment algorithm C2 extension teardrop fractures are avulsion fractures with an intact anterior longitudinal ligament displacing and anteriorly rotating the anteroinferior vertebral body fragment. The clinical outcome resulted in a median overall VAS-FA of 95 (IQR 89-98), Karlsson Score of 90 (IQR 82-100) and SF-12 PCS of 56 (IQR 53-58) / SF-12 MCS 55 (48-58). Fractures of the calcaneus. Talar avulsion fractures and stress fractures may cause less disability. 8600 Rockville Pike It is the origin of the bifurcate ligament and occasionally of the extensor digitorum brevis ( Figure 4 ; References 4, 5 ). Although recent studies have reported a higher incidence, these injuries have yet received little attention in clinical research. Hirschmann A, Walter W, Alaia E, Garwood E, Amsler F, Rosenberg Z. Acute Fracture of the Anterior Process of Calcaneus: Does It Herald a More Advanced Injury to Chopart Joint? This consists of immobilization in a walker boot for typically six weeks, until the soft tissue injury and fracture have healed. The coronoid process is a triangular projection on the anterior surface of the third olecranon bone. The gold standard diagnostic test for confirming an anterior tibialis rupture is magnetic resonance imaging (MRI). J Bone Joint Surg . Fractures to the anterior process of the calcaneus (APC) have long been considered rare injuries. The literature on anterior end of the calcaneum fractures occurring due to abduction forces is sparse, and the management protocols for such injuries are ill defined. The influence of age, sex, fracture type/characteristics, and concomitant injuries on the outcome parameters was analyzed. The fracture is classified as an extra-articular calcaneal fracture (does not involve subtalar joint) but can extend to the calcaneocuboid joint. As discussed in Wheeless' Textbook of Orthopaedics (2012), this is the most common mechanism of injury to result in anterior process fractures of the calcaneus. 2021 Feb;9(4):333. doi: 10.21037/atm-20-7824. Hemarthrosis is a condition where there is blood and swelling within a joint. Imaging Plain radiographs: Foot and ankle anteroposterior/lateral/oblique views to access adjacent joints: i. This type of fracture commonly occurs during a high-energy event such as a car crash or a fall from a ladder when the heel is crushed under the weight of the body. This site needs JavaScript to work properly. Unfortunately, she had continued symptoms with prolonged weight bearing, ambulation on uneven surfaces, and was not able to return to activities any more strenuous than walking. The anterior process off the calcaneus is located at the anterior (front) portion of the heel bone.X-ray and ultrasound examination can show an anterior process of the calcaneum fracture. HHS Vulnerability Disclosure, Help The anterior process of the calcaneus (APC) is a saddle-shaped osseus projection that articulates with the cuboid anteriorly to form the calcaneo-cuboid joint and forms the anterior subtalar joint superiorly. A fracture of the calcaneus, or heel bone, can be a painful and disabling injury. Nonoperative management with protected weight bearing and immobilization is frequently successful if the fracture is correctly diagnosed at the outset (Berkowitz & Kim, 2005; Lui, 2011). Note swelling, bruising, and blister formation along the lateral hindfoot. Transverse Fracture Transverse fractures are a type of broken bone. Foot Ankle Int. Ouellette H., Salamipour H., Thomas B., Kassarijian A., Torriani M. (2006). A loma and . official website and that any information you provide is encrypted She noted initial improvement but plateaued in therapy after the first 3 weeks. Retrospective register study with prospective follow-up. To evaluate the incidence and pattern of spinous process fractures (SPFs) in patients with osteoporotic compression fractures (OCFs) of the thoracolumbar spine. The bottom of the lateral process forms the anterior portion of the posterior subtalar joint. Patient-Reported Outcome Following Operative and Conservative Treatment of Calcaneal Fractures: A Retrospective Analysis of 79 Patients at Short- to Midterm Follow-Up. 36 Highly Influential View 2 excerpts, references background It may look swollen and red. Supports anterior and middle facets, articulates with calcaneocuboid joint. Radiographic evaluation included anteroposterior, lateral, and mortise with a gravity stress view of the ankle. The MRI revealed the known anterior process fracture without significant displacement, bone contusions throughout the midfoot, split tear of the peroneus brevis, and partial tear of the anterior talofibular ligament. Keywords: The anterolateral fragment refers to the lateral wall of the anterior process; this fragment is typically pyramid shaped and can include a portion of the calcaneocuboid . Foot fractures frequently misdiagnosed as ankle sprains. . {"url":"/signup-modal-props.json?lang=us\u0026email="}, O'Donnell C, Anterior process of calcaneus fracture. (1993). a ladder or roof). 27 patients (38 years, IQR 29-58), 74% female with a median follow up of 24 months (IQR 16-41) were included. Later changes in the swelling must be inquired similar to softening, ulceration, fungation and inflammatory. Of patients who were receiving stable doses fractures, swelling and delirium. Delays in appropriate diagnosis and treatment, as is noted in this case study, can ultimately result in long-term disability, continued ankle symptoms, and the need for surgery (Judd & Kim, 2002; Lui, 2011). Muscles, tendons, ligaments, and nerves may also be injured. The https:// ensures that you are connecting to the Most anterior process fractures of the calcaneus can be treated non-surgically. The patient was fitted for a walking boot and provided crutches with return demonstration of proper use. American Family Physician, 66(5), 785-794. Schematic drawing of the calcaneus as seen from its superior surface. Avulsion of the anterior process of the calcaneus accounts for nearly 15% of calcaneal fractures according to some sources. A sling is commonly used in these cases. The reported annual incidence of calcaneal fractures is 11.5/100,000, with 72% of these fractures resulting from a fall (Hatch & Dean, 2015). 2021 May 28;8:620964. doi: 10.3389/fsurg.2021.620964. Soft tissue swelling overlying the dorsal talus and navicula but no obvious fracture. Note medial clear space widening on the gravity stress view (right). 1996 Jun;17(6):360-6. doi: 10.1177/107110079601700612. You have new problems urinating or having bowel movements. An inversion motion of the plantar-flexed ankle is thought to increase stress at the insertion of the bifurcate ligament, with subsequent avulsion of a fragment of bone from the APC [3]. Most of the time, it includes breaks in both the tibia and fibula of the lower leg. Anterior and posterior tibial pulses and distal capillary refill should be examined via palpation and or Doppler to assess for any vascular deficits. Using knee support and crepe bandage , had Zerodol sp for pain and swelling Asked anonymously on 3rd January, 2022 at 2:01 pm 2018;210(5):1123-30. . 22 because of the. Use a sling to rest the elbow in place. Unable to load your collection due to an error, Unable to load your delegates due to an error. Physical examination revealed an alert, oriented, affect-appropriate female in no apparent distress. The marked surrounding soft tissue swelling in an indication of the trauma involved in producing such a fracture. Signs and symptoms depend on where the fracture happened and how severe it is: Sudden, sharp, stabbing pain that may be severe or worse when you move or breathe Dull pain that continues for several days or weeks Swollen, numb, bruised, or tingling skin over the fracture area Muscle weakness Trouble moving your body where the fracture happened Methods: Pins or screws may be needed . The pain was noted to be moderate, sometimes severe, with weight-bearing activities. Calcaneus fractures. and transmitted securely. The anterior part of the calcaneus is tapered distally. Last updated on Dec 2, 2022. Ni M, Lv ML, Sun W, Zhang Y, Mei J, Wong DW, Zhang H, Jia Y, Zhang M. Ann Transl Med. Retrieved from http://www.wheelessonline.com/ortho/frx_of_the_anterior_calcaneal_process[Context Link], Join NursingCenter on Social Media to find out the latest news and special offers. Clinical presentation of subtle fractures can be similar to that of ankle sprains, and these fractures are frequently missed on initial examination (Judd & Kim, 2002). 1998;117 (4-5): 300-2. The majority of anterior process fractures of the calcaneus can be successfully treated with protected weight bearing in a short leg cast or walking boot immobilization for 4-6 weeks ( Berkowitz & Kim, 2005; Lui, 2011 ). Skeletal Radiology, 36(7), 627-632. Third degree Lateral Ankle Sprain. Conclusion: This is usually related to the amount of force that was used to cause the break. Calcaneal fracture rep- The calcaneus secundarius (CS) is an accessory ossicle of the anterior facet of the calcaneus and is usually asymptomatic. She described this as a forceful inversion of the ankle with plantarflexion, causing compression of the forefoot. Endoscopic excision of symptomatic nonunion of anterior calcaneal process. As the lateral process is involved in both the ankle and subtalar joints, it is important in almost all foot movements. Case study, Radiopaedia.org (Accessed on 12 Dec 2022) https://doi.org/10.53347/rID-47498. This injury is called a pilon fracture, and is the result of severe axial compression that is transmitted through the foot and ankle joint to the distal tibia [10-11]. The hematoma directed us to the calcaneocuboidal joint. Acromion is the sideway extension of the backbone on the shoulder plate. If the fracture fragment is not interfering with the function of the calcaneal cuboid joint, non-operative treatment is indicated. Adults with acute unilateral fractures to the APC and concomitant injuries limited to the Chopart joint line, treated by full weight-bearing, with a follow-up of 12 months were included. There was no gross deformity or discoloration. Accurate diagnosis and timeliness of appropriate intervention are essential for optimal patient outcomes. She had been taking acetaminophen (Tylenol) three times daily with minimal improvement. Part II: Treatment. It acts as a bony buttress to prevent posterior dislocation; additional stability is provided by its three soft insertions, namely the anterior joint capsule of the elbow, the brachialis muscle and the medial ulnar collateral ligament. Clipboard, Search History, and several other advanced features are temporarily unavailable. The fracture is classified as an extra-articular calcaneal fracture (does not involve subtalar joint) but can extend to the calcaneocuboid joint. Anterior process calcaneal fractures: A systematic evaluation of associated conditions. With anterior ankle impingement, the pain is worse with walking or running up hill, inclines or stairs. Given her concurrent pregnancy, acetaminophen was the medication of choice for pain management. This period allows for any swelling and fracture blisters to resolve completely, but the procedure is still sufficiently early to prevent premature healing and coalescence of the fracture fragments. All rights reserved. Only few case reports/series, all suffering multiple methodical shortcomings, exist. Careers. What is coronoid process fracture? An official website of the United States government. A nondisplaced fracture of the elbow bone may cause severe pain and reduced range of motion of the arm. [Context Link], Lui T. H. (2011). Upon presentation, she described continued swelling of the ankle, only minimally improved with rest, elevation, and icing. Fracture characteristics (Degan classification, displacement, intra-articular involvement, comminution) were assessed in CT scans. No joint space widening usually is seen, for the ligaments around the ankle joint are very sturdy and do not allow for much in the way of joint distraction. These facets are oriented in slightly different geometric planes and articulate with the inferior aspect of the talus to form the anterior, middle, and posterior subtalar joints. She was frustrated by this lack of improvement and so presented to this orthopaedic nurse practitioner for further evaluation. Disclaimer, National Library of Medicine Severe Ecchymosis and swelling (>4 cm at fibula) Unable to bear weight. Introduction of a modified Degan classification to specify treatment algorithms in fractures of the anterior process of the calcaneus. The rate of these fractures is as high as 9-10 % [ 16 ]. You have questions or concerns about your condition or care. This fracture is caused by a compressive downward force that is transmitted evenly through the occipital condyles to the superior articular surfaces of the lateral masses of C1. It's location is the anterior side of the ankle in the talocrural joint. reported excision of the anterior tuberosity of the calcaneus for treatment of chronic pain . A pilon fracture is a type of break of the shinbone (tibia) that happens near the ankle. AJR Am J Roentgenol. This type of injury is caused by a strong local impact of an object (e.g., a hammer) (Fig. Use the menu to find downloaded articles. Examples include flake fractures of the cuboid at the calcaneo-cuboid ligament, avulsion of the calcaneus anterior process at the calcaneo-navicular ligament, forced plantar flexion incident at the dorsal talo-navicular ligament (dorsum of talus head) and avulsion at the base of the fifth metatarsal, which can occur by clipping a heel on step . Percutaneous treatment of high-risk patients with intra-articular calcaneus fractures: a case series. Figure 1. The majority of anterior process fractures of the calcaneus can be successfully treated with protected weight bearing in a short leg cast or walking boot immobilization for 4-6 weeks (Berkowitz & Kim, 2005; Lui, 2011). Squatting (eg with weight lifting) and landing after a jump (eg gymnastics or acrobatics) may make this pain worse. [Fractures of the anterior process of the calcaneus]. Because of this calcaneal fractures tend to come with other problems that vary with the extent of the injury. What is a pilon fracture? Fractures of the anterior process of the calcaneus. 2. Contact sports or a sport that causes you to twist your body, Shoveling something heavy, such as snow or rocks, Sudden, sharp, stabbing pain that may be severe or worse when you move or breathe, Dull pain that continues for several days or weeks, Swollen, numb, bruised, or tingling skin over the fracture area, Trouble moving your body where the fracture happened. the presence (yes, no, or equivocal) of subfibular soft-tissue swelling on anteroposterior . anterior process fractures secondary to compression generally occur when the foot is forcefully dorsiflexed and the anterior process is pressed against the cuboid. Yet, this fracture rarely has been reported in the radiology literature. Antalgic gait, wearing neoprene ankle support. UpToDate. First, your physician may perform a clinical examination and assess swelling, range of motion of your foot, and the strength of the muscles around your foot. 3. Journal of the American Academy of Orthopedic Surgeons, 13(8), 492-502. The patient was fitted for a walking boot and provided crutches with return demonstration of proper use. Calcaneal and Lisfranc fractures usually cause severe swelling and disability, so clinically, if they are missed initially, the patient will likely seek care again soon. A fracture of the anterior process was immediately visible with ultrasound by the cleft visible, and the widening of the jintspace of the calcaneocuboidal joint (US image calcaneal process). Complications following the extended lateral approach for calcaneal fractures do not influence mid- to long-term outcome. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. The aim of this study was to objectively evaluate the outcome after fractures to the APC treated by full weight bearing and to investigate the influence of fracture characteristics. 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