![]() The postero-lateral bony prominence of the calcaneal tuberosity was palpable. Physical examination revealed swelling and ecchymosis around the entire hind- and midfoot, with an abrasion wound in the posterior area of the heel. Due to open wound in the posterior region of the heel and inability of baring weight and walking, the patient seek help in the nearest hospital. The patient felt and immediate acute pain and incapacity, falling to the ground. This caused the distal part of the foot to undergo a downward axial movement, while the more posterior region of the heel (corresponding to the calcaneal tuberosity area) remained supported on the floor, therefore leading to a displacement of both mid- and forefoot areas relatively to hindfoot. The heel stayed partially positioned on the sidewalk, whereas the rest of the foot (firmly placed towards the center of the cover) followed the cover's movement as it gave up a few centimeters. The patient was walking on the street when she stepped into a manhole cover with her left foot, unaware that the cover was partially loose. She was medicated for high blood pressure and dyslipidemia, and had previous medical history of left mastectomy due to breast carcinoma and right hemicolectomy due to intestinal adenocarcinoma - both in remission for more than 5 years). The authors describe the case of a 62-year-old female who was admitted to the Emergency Department due to a left foot injury. The management of TTCF is distinctly different from other calcaneal fractures, as urgent surgery may be required. Radiographs are typically the initial method of investigation. Nevertheless, TTCF can also occur after relatively minor trauma in patients with compromised bone quality. This results in the lateral process of the talus being driven into the calcaneus, which, depending on the position of the subtalar joint, may result in a TTCF (or a depressed variant). The typical mechanism of injury in younger individuals is a high-energy injury with an axial load applied to the heel. Plantarflexion of this tongue piece can lead to increased pressure of the soft tissues overlying this fragment, what can compromise their blood supply and result in catastrophic secondary soft tissue lesion. ![]() The superior fragment is often displaced posteriorly and superiorly to varying degrees, because of the insertion of the Achilles tendon and consequent pull motion of the triceps surae complex. TTCF is characterized by a secondary fracture line exiting posteriorly through the calcaneal tuberosity in continuity with some or all of the posterior facet, causing the separation of the calcaneal tuberosity into superior and inferior fragments. ![]() ![]() Tongue-type calcaneus fractures (TTCF) make up 25-35% of intraarticular calcaneal fractures. One of the morphological variants of calcaneal fractures is the tongue-type fracture, which represents an unique an relatively uncommon injury pattern to the bone and soft tissues. Approximately, 75% of calcaneal fractures are intraarticular. They are the most commonly diagnosed tarsal bone fractures in emergency medicine. Although this type of fracture is often associated to high-energy injuries in younger individuals, we present a case of a 62-year-old female with tongue-type calcaneal fracture due to minor trauma.Ĭalcaneus fractures represent 60% of all tarsal bone fractures and 2% of all fractures. Early recognition by the emergency physician and prompt operative repair prevent further injury and obviate the need for surgical soft tissue coverage or potential amputation. The displacement of the superior fragment has the potential to tent the skin of the posterior heel and, if not treated emergently, partial or full-thickness skin breakdown can progress quickly, and potential necrosis can occur. Tongue-type fractures are unusual calcaneal fractures that produce an unique and relatively uncommon injury pattern to the bone and soft tissues, due to the separation of the calcaneal tuberosity into superior and inferior fragments.
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