Ankle and Foot 47 - Department of Radiology - University of ...
Ankle and Foot 47 - Department of Radiology - University of ... Ankle and Foot 47 - Department of Radiology - University of ...
2274 VII Imaging of the Musculoskeletal System APC Figure 47-82. Anterior process of the calcaneus (APC) fracture in a 48-year-old who fell while standing on a picnic table, sustained a twisting injury to the foot. This lateral radiograph was obtained in the emergency department the next day. The arrowheads in the magnified dashed box show the minimally displaced lucent fracture lines through the APC. The patient did well after nonoperative treatment with a non– weight-bearing cast for 12 weeks. A C B D Figure 47-83. Anterior process of the calcaneus (APC) fracture in a 29-year-old who tripped down some steps. A, Oblique, non–weight-bearing foot radiograph shows a nondisplaced APC fracture (white arrowheads in magnified dashed box). B, Radiographs 6 months later show that the APC fracture is still unhealed. CT scans were also obtained on the same day as the initial radiographs. C, Source axial images through both hindfeet reveal the minimally displaced transverse fracture (white arrowheads in dotted magnified box) of the left APC. The contralateral right foot serves as a useful normal comparison when both feet are included in the small scanning field of view. D, Sagittal reformatted image shows the ACP fracture disrupting the superior cortex (arrow). The acute fracture margins are not corticated. The patient was initially treated conservatively, including 4 months of non–weight bearing and 4 months with a bone stimulator. When the patient remained symptomatic 7 months later, a repeat CT scan was requested. Ch047-A05375.indd 2274 9/9/2008 5:35:21 PM
47 Ankle and Foot 2275 47 E F G H Figure 47-83, cont’d E, The axial source images reveal that the transverse fracture remains nonunited (arrowheads in magnified dashed box). F, The sagittal image shows that the fracture margins are becoming sclerotic and corticated (arrow), a sign of nonunion. Because CT confirmed the clinical suspicion that the APC fracture was not healing, surgical intervention was warranted. G, Oblique radiograph obtained portably in the recovery room immediately after open reduction and internal fixation shows the lucent fracture line (arrowheads) bridged by a Whipple-type Herbert screw. H, Oblique radiograph obtained 9 months after surgery reveals that the fracture lines are essentially healed and barely discernible (arrowheads). Ch047-A05375.indd 2275 9/9/2008 5:35:22 PM
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<strong>47</strong> <strong>Ankle</strong> <strong>and</strong> <strong>Foot</strong> 2275 <strong>47</strong><br />
E<br />
F<br />
G<br />
H<br />
Figure <strong>47</strong>-83, cont’d E, The axial source images reveal that the transverse fracture remains nonunited (arrowheads in magnified dashed box).<br />
F, The sagittal image shows that the fracture margins are becoming sclerotic <strong>and</strong> corticated (arrow), a sign <strong>of</strong> nonunion. Because CT confirmed the<br />
clinical suspicion that the APC fracture was not healing, surgical intervention was warranted. G, Oblique radiograph obtained portably in the<br />
recovery room immediately after open reduction <strong>and</strong> internal fixation shows the lucent fracture line (arrowheads) bridged by a Whipple-type<br />
Herbert screw. H, Oblique radiograph obtained 9 months after surgery reveals that the fracture lines are essentially healed <strong>and</strong> barely discernible<br />
(arrowheads).<br />
Ch0<strong>47</strong>-A05375.indd 2275<br />
9/9/2008 5:35:22 PM
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