UMEM Educational Pearls

Title: What's the Diagnosis? Written by Dr. Ari Kestler

Posted: 7/10/2011 by Haney Mallemat, MD (Emailed: 7/11/2011) (Updated: 8/28/2014)
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Question

48 year old male following 15 foot fall onto both feet. What is the diagnosis?
…and why is it called the “Lover’s Fracture”?

Answer

Answer: Calcaneus fracture; historically called the “Lover’s Fracture” for “lovers” jumping out of bedroom windows to evade suspicious spouses and landing directly on their feet.

Calcaneus fractures

Most commonly fractured tarsal bone
2 types:
- Extra-articular fracture from direct blow, twisting force and repetitive forces (causing stress fractures)
- Intra-articular fracture from axial loading secondary to fall >6 feet, motor vehicle crash, etc; this is the classic “lover’s fracture”
10% of axial loaded intra-articular fractures associated with:
- Bilateral calcaneus fractures and/or,
- Thoracic or lumbar compression fractures and/or,
- Proximal femur or tibial plateau fractures
Ankle Xray is diagnostic for fractures and to measure Bohler’s angle (angle formed by intersection of lines connecting apex of anterior process with the apex of posterior facets and apex of posterior facet with the posterior tuberosity; see figure below)
- Normally 20-40 degrees; <20 degrees increases suspicion for intra-articular fracture
Ankle CT in select cases; Xray may underestimate some injuries
Typically, extra-articular fractures treated with closed reduction and casting, while intra-articular fractures by open reduction and internal fixation (closed reduction in select cases)

References

Rosen's Emergency Medicine: Online Edition

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