Imaging of Hindfoot Fractures

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 2.75
Procedures: 2.75
Head, Spine, and Musculoskeletal: 2.75

Magnetic Resonance Imaging: 0.25
Procedures: 0.25
Musculoskeletal: 0.25

Nuclear Medicine Technology: 0.25
Procedures: 0.25
Other Imaging Procedures: 0.25

Radiography: 2.75
Procedures: 2.75
Extremity Procedures: 2.75

Registered Radiologist Assistant: 2.75
Procedures: 2.75
Musculoskeletal and Endocrine Sections: 2.75

Sonography: 0.25
Procedures: 0.25
Superficial Structures and Other Sonographic Procedures: 0.25

Outline

1. Introduction
2. Talus
   1. Anatomy
   2. Epidemiologic Features
   3. Imaging
   4. Classification
   5. Talar Body
      1. Compression or Osteochondral Dome Trochlear Fractures
      2. Shear Trochlear Fractures
      3. Crush Comminuted Trochlear Fractures
      4. Posterior Process Fractures
      5. Lateral Process Fractures
   6. Talar Neck
   7. Talar Head
   8. Subtalar and Total Talar Dislocations
3. Calcaneus
   1. Anatomy
   2. Epidemiologic Features
   3. Imaging
   4. Pathologic-Anatomic Features
   5. Imaging Assessment and Classifications
      1. Radiological Assessment with Essex-Lopresti Classification
      2. Tongue Type
      3. Joint Depression Type
   6. CT Assessment with Sanders Classification
   7. Management
4. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the frequency of fractures in the hindfootknow the anatomy of the ankle and foot
2. be familiar with the arteries supplying the talusrecognize the frequency of fractures in the talus
3. be familiar with the ipsilateral extremity injuries accompanying talar fractures
4. understand the use of CT for diagnosing talar fracturesknow the classification of talar fractures
5. be familiar with the Inokuchi et al definition of talar neck fractures
6. recognize the common type of talar body fractures
7. be familiar with the dome compression fractures of the talar body
8. be familiar with the classification systems for staging osteochondral defects of the talus
9. recognize the patterns for isolated shear fractures
10. be familiar with shear fractures of the talus
11. understand the risk of avascular necrosis in crush comminuted trochlear fractures of the talar body
12. be familiar with Shepherd fractures of the talusrecognize “snowboarder” fractures of the talus
13. be familiar with the differing type and complications of talar body fractures
14. know the mechanism of injury associate with lateral process fractures of the talar body
15. be familiar with the classification system use for lateral process fractures of the talus
16. understand the use of CT for diagnosing lateral process fracturesknow the causes of modern talar fractures
17. be familiar with the classification of talar neck fractures
18. be familiar with the Hawkins-Canales typing of fractures
19. be familiar with the frequency of avascular necrosis using the Hawkins sign
20. identify the imaging modalities that can be used to help determine viable blood supply in patients with talar neck fractures
21. identify the distinct fracture patterns found in the talar head
22. be familiar with talar neck fractures associated with subtalar dislocationknow the mechanism of injury for talar neck fractures
23. be familiar with type III Hawkins-Canales talar neck fractures
24. be familiar with the anatomy of the hindfoot
25. be familiar with the surfaces of the calcaneus
26. be familiar with the articular facets of the calcaneusidentify the largest calcaneal articular facet
27. recognize the Achilles tendon insertion site on the calcaneus
28. be familiar with the thalamic portion of the calcaneus
29. recognize the calcaneus as the most frequently fractured tarsal bone
30. recognize the use of the lateral view for measuring Bohler and Gissane angles
31. understand the patient outcome resulting from a wide, short, and depressed calcaneus
32. be familiar with the Essex-Lopresti classification system
33. recognize the advantages of CT for calcaneal fractures
34. be familiar with the Sanders classification system for the posterior joint surface of the calcaneus
35. recognize the prevalence of compartment syndrome for patients with calcaneal fractures
36. be familiar with the orthopedic goal for managing patients with calcaneal fractures