Maine Orthopaedic Review Monthly Challenge

Test Your Knowledge of Bone Fractures

Bruce F. Gomberg, MD; Brad J. Yoo, MD


March 08, 2017

Axial load to the hindfoot results in pathologic contact between the talus lateral process and the critical angle of Gissane. The resultant primary fracture line is oriented in an anterolateral to posteromedial direction. Depending upon the magnitude of injury, additional fracture lines may emanate from this initial strike point. These secondary fracture lines frequently extend into the anterior process resulting in sagittally oriented displaced fractures. Secondary fracture lines may also cleave into the posterior facet resulting in an Essex-Lopresti joint depression fracture. As the posterior talocalcaneal articular fragment is depressed into the midsubstance of the calcaneal body, a burst-type moment is created, with the expulsion of the lateral wall laterally. Further fracture extension may travel medially to involve the medial facet. The interosseous talocalcaneal ligament remains intact during the axial loading, and its attachment to the sustentaculum tali ensures that this fragment remains relatively anatomic post-injury. Recent studies, however, challenge the concept that this fragment remains "constant" in all cases.[2]


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