Calcaneal fractures in occupants involved in severe frontal motor vehicle crashes.

The calcaneous is the largest tarsal bone in the foot and plays an important role in walking and running. Motor vehicle crashes and falls from elevation have been associated with calcaneal fractures. Although not life-threatening, these injuries may result in permanent disability. This study used the Crash Injury Research and Engineering Network (CIREN) database to describe calcaneal fractures and concomitant lower extremity skeletal injury patterns for occupants involved in motor vehicle crashes. Sixty-three drivers and 7 front row passengers with calcaneal fractures were identified in the CIREN database during 1997-2005. Almost all these occupants were involved in severe (based on the delta V and vehicle crush) frontal or off-set frontal crashes with toe pan intrusion. Eighty-four percent of the calcaneal fractures were intra-articular or partially articular. Overall, 93% of occupants also had injury to other body regions with 84% having other lower extremity fractures. One year after the crash, most occupants had not returned to their prior level of physical functioning. Surgically managing patients with calcaneal fractures for an optimal outcome remains a challenge for orthopedic surgeons. Because lower extremity injuries, including calcaneal fractures, may cause permanent disability, it is important to prevent these injuries through structural improvements in motor vehicle design.

[1]  Rolf H. Eppinger,et al.  Ankle joint injury mechanism for adults in frontal automotive impact , 1991 .

[2]  M F Swiontkowski,et al.  Physical impairment and functional outcomes six months after severe lower extremity fractures. , 1993, The Journal of trauma.

[3]  G S Beaupré,et al.  Calcaneal loading during walking and running. , 2000, Medicine and science in sports and exercise.

[4]  B. Sangeorzan,et al.  Fractures of the calcaneus. , 2002, The Orthopedic clinics of North America.

[5]  P C Dischinger,et al.  Airbag protection versus compartment intrusion effect determines the pattern of injuries in multiple trauma motor vehicle crashes. , 1996, The Journal of trauma.

[6]  James K. Conlee,et al.  Blow-Molded Plastic Active Knee Bolsters , 2004 .

[7]  M. Swiontkowski,et al.  Patient-Oriented Functional Outcome After Unilateral Lower Extremity Fracture , 1993, Journal of orthopaedic trauma.

[8]  S. Lawrence,et al.  Evaluation and treatment of open calcaneal fractures: a retrospective analysis. , 2003, Orthopedics.

[9]  A M Eigen,et al.  THE RELATIONSHIP BETWEEN OCCUPANT COMPARTMENT DEFORMATION AND OCCUPANT INJURY , 2004 .

[10]  E. Rohr,et al.  Are drivers more likely to injure their right or left foot in a frontal car crash: a crash and biomechanical investigation. , 2002, Annual proceedings. Association for the Advancement of Automotive Medicine.

[11]  G. McNaughton,et al.  Spontaneous Avulsion Fracture Of The Calcaneus In A Non-Diabetic Patient , 2006 .

[12]  J H Siegel,et al.  Safety belt restraints and compartment intrusions in frontal and lateral motor vehicle crashes: mechanisms of injuries, complications, and acute care costs. , 1993, The Journal of trauma.

[13]  J. Calhoun,et al.  Fractures of the Calcaneus Part II: Treatment , 1996, Foot & ankle international.

[14]  R. Buckley,et al.  An economic evaluation of operative compared with nonoperative management of displaced intra-articular calcaneal fractures. , 2005, The Journal of bone and joint surgery. American volume.

[15]  P C Dischinger,et al.  Consequences and costs of lower extremity injuries. , 2004, Annual proceedings. Association for the Advancement of Automotive Medicine.

[16]  Burdeaux Bd.  Reduction of calcaneal fractures by the McReynolds medial approach technique and its experimental basis. , 1983 .

[17]  N Yoganandan,et al.  Biomechanics of Calcaneal Fractures: A Model for the Motor Vehicle , 2001, Clinical orthopaedics and related research.

[18]  N. Ebraheim,et al.  Calcaneus Fractures With Subluxation of the Posterior Facet: A Surgical Indication , 2000, Clinical orthopaedics and related research.

[19]  J. Calhoun,et al.  Fractures of the Calcaneus Part I: Anatomy, Injury Mechanism, and Classification , 1996, Foot & ankle international.

[20]  W. Haddon,et al.  The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. , 1974, The Journal of trauma.

[21]  R. Sanders,et al.  Operative Treatment in 120 Displaced Intraarticular Calcaneal Fractures Results Using a Prognostic Computed Tomography Scan Classification , 1993, Clinical orthopaedics and related research.

[22]  P C Dischinger,et al.  Lower extremity injuries in drivers of airbag-equipped automobiles: clinical and crash reconstruction correlations. , 1995, The Journal of trauma.

[23]  J. Ware,et al.  International quality of life assessment (IQOLA) project , 1992, Quality of Life Research.

[24]  N. Ebraheim,et al.  Sinus Tarsi Approach with Trans-articular Fixation for Displaced Intra-articular Fractures of the Calcaneus , 2000, Foot & ankle international.