A 68-year-old woman with osteoporosis sustains an axial loading injury to her heel after a fall from standing height. She has severe heel pain, swelling, and ecchymosis extending to the sole. Bohler's angle is 10° on lateral radiograph. CT shows depression of the posterior facet of the subtalar joint. The most important associated injury to evaluate in this patient is:
- A Lumbar vertebral compression fracture ✓
- B Proximal fifth metatarsal fracture
- C Contralateral ankle fracture
- D Talar neck fracture
Correct answer: A. Lumbar vertebral compression fracture
Explanation
Calcaneal fractures from axial loading in elderly osteoporotic patients are strongly associated with concomitant thoracolumbar compression fractures. Bohler's angle is normally 20-40°; depression below 20° confirms a depressed calcaneal fracture. The same axial force mechanism that fractures the calcaneus often produces a lumbar compression fracture, which must be actively sought. The other associations are not typical for this mechanism.
Reference: Rockwood and Green's Fractures in Adults, 9th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.