CALCANEAL FRACTURES IN DIABETIC-PATIENTS

We would like to present 23 calcaneal fractures in 22 patients of whom 21 had type I diabetes mellitus. There appear to be three basic fract ure types: (1) a superiorly displaced extra-articular avulsion fractur e of the posterior calcaneus (or Iowa fracture), which occurred in 12 patients (five men, seven women); (2) a mid-calcaneal compression frac ture in six patients (four men, two women), and (3) a cleavage or ''we dge'' type fracture in four patients extending from the calcaneal tube rcle (one man, 3 women). Ail four of this last group of patients had a history of a chronic penetrating ulcer, and this is noteworthy since only one other patient out of the remaining 18 in groups 1 and 2 had a similar history. Most patients had decreased bone mineralization: 15 patients were on long-term, high-dose steroids, and 18 patients had ei ther poor renal function or complete renal failure (II of 12). Fourtee n patients had received either renal or pancreas transplants. Eight pa tients were on restricted weight bearing-prior-to-their fractures. We believe that diabetic patients are more prone to calcaneal fractures t han the general population, and early diagnosis is imperative, followe d by early treatment to prevent significant bony deformity. (C) 1998 E lsevier Science Inc.