UMEM Educational Pearls

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

Posted: 11/18/2013 by Haney Mallemat, MD
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Question

48 year-old presents after falling 15 feet following a “misunderstanding” with police. What's the diagnosis? ...and for a bonus question, why is this called a “Lover’s Fracture”?

Answer

Calcaneus fracture

Answer to Bonus Question: Historically called a “Lover’s Fracture” for “lovers” jumping out of bedroom windows (to evade suspicious spouses) who then land directly on their feet.

Calcaneus fractures

Most commonly fractured tarsal bone
2 types:
- Extra-articular fracture (direct blow), twisting, and repetitive forces
- Intra-articular fracture from axial loading secondary to fall >6 feet, motor vehicle crash, etc.; (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 and to measure Bohler’s angle (see figure below)
- Normally 20-40 degrees
- <20 degrees increases suspicion for intra-articular fracture
Ankle CT in select cases as Xray may underestimate some injuries
Extra-articular fractures treated with closed reduction and casting and intra-articular fractures treated by open reduction and internal fixation (closed reduction in select cases)

References

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