Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
권호 표지
DOI QR코드

DOI QR Code

Correlation Analysis of Reduction for Intra-Articular Calcaneal Fracture and Clinical Outcomes Using Postoperative Computed Tomography

수술 후 컴퓨터 단층촬영을 이용한 관절 내 종골 골절의 정복과 임상 결과 간의 연관성 분석

  • Eom, Joon-Sang (Department of Orthopaedic Surgery, Konkuk University School of Medicine) ;
  • Joo, Young-Deuk (Department of Orthopaedic Surgery, Konkuk University School of Medicine) ;
  • Kim, Seong-Jun (The Armed Forces Yangju Hospital) ;
  • Shin, Min-Ho (LCT Hospital) ;
  • Lee, Dong-Oh (Department of Orthopaedic Surgery, Konkuk University School of Medicine) ;
  • Jung, Hong-Geun (Department of Orthopaedic Surgery, Konkuk University School of Medicine)
  • 엄준상 (건국대학교 의학전문대학원 정형외과학교실) ;
  • 주영득 (건국대학교 의학전문대학원 정형외과학교실) ;
  • 김성준 (국군양주병원) ;
  • 신민호 (이춘택병원 정형외과) ;
  • 이동오 (건국대학교 의학전문대학원 정형외과학교실) ;
  • 정홍근 (건국대학교 의학전문대학원 정형외과학교실)
  • Received : 2014.06.30
  • Accepted : 2014.10.26
  • Published : 2014.12.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: We evaluated the correlation of postoperative clinical outcomes and radiologic findings using computed tomography and simple X-ray in intra-articular calcaneal fractures. Materials and Methods: The current study is based on 41 feet, 38 patients with displaced intra-articular fracture who underwent surgical treatment with at least one year of follow-up. Evaluation of clinical outcome included American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, visual analogue scale (VAS) score, and subjective satisfaction. A simple X-ray was used in evaluation of preoperative and postoperative Gissane angle, B${\ddot{O}}$hler angle, and calcaneal fracture width. Computed tomography scan was performed for evaluation of preoperative and postoperative articular step-off and articular gap in all cases. Finally, we evaluated the correlation of the postoperative clinical outcomes and radiologic findings based on the measurement. Results: The average postoperative AOFAS score and VAS score was $84.1{\pm}8.5$ and $2.2{\pm}2.2$. Subjective satisfaction was excellent in 15 cases, good in 19 cases, and fair in seven cases. The average B${\ddot{O}}$hler angle was restored from $11.1^{\circ}$ to $24.7^{\circ}$(p<0.05), Gissane angle was changed from $121.0^{\circ}$ to $119.0^{\circ}$ (p>0.05), and the average width was restored from 45.8 to 35.0 mm (p<0.05). The average articular step-off and gap were decreased from 6.3 to 2.0 mm and from 11.1 to 4.6 mm, respectively (p<0.05). No significant correlations were observed between the clinical outcome and Gissane angle, B${\ddot{O}}$hler angle, and width, and there was no significant correlation between the clinical outcome and Sanders classification. However, postoperative articular step-off showed correlation with VAS and AOFAS score and articular gap showed correlation with VAS score. Conclusion: The clinical outcome did not show correlation with B${\ddot{O}}$hler angle and Gissane angle but did show correlation with anatomical reduction of the posterior facet joint.

Keywords

References

  1. Cave EF. Fracture of the os calcis--the problem in general. Clin Orthop Relat Res. 1963;30:64-6.
  2. Ebraheim NA, Elgafy H, Sabry FF, Tao S. Calcaneus fractures with subluxation of the posterior facet. A surgical indication. Clin Orthop Relat Res. 2000;(377):210-6.
  3. Hildebrand KA, Buckley RE, Mohtadi NG, Faris P. Functional outcome measures after displaced intra-articular calcaneal fractures. J Bone Joint Surg Br. 1996;78:119-23.
  4. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg Am. 2000;82:225-50. https://doi.org/10.2106/00004623-200002000-00009
  5. Magnan B, Bortolazzi R, Marangon A, Marino M, Dall'Oca C, Bartolozzi P. External fixation for displaced intra-articular fractures of the calcaneum. J Bone Joint Surg Br. 2006;88:1474-9.
  6. Kurozumi T, Jinno Y, Sato T, Inoue H, Aitani T, Okuda K. Open reduction for intra-articular calcaneal fractures: evaluation using computed tomography. Foot Ankle Int. 2003;24:942-8. https://doi.org/10.1177/107110070302401214
  7. Parmar HV, Triffitt PD, Gregg PJ. Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study. J Bone Joint Surg Br. 1993;75:932-7.
  8. Chung HJ, Ahn JK, Bae SY, Jung H. Operative treatment of intraarticular calcaneal fractures using extensile lateral approach. J Korean Foot Ankle Soc. 2009;13:60-7.
  9. Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res. 1993;(290):87-95.
  10. Chapman MW. Calcaneus fractures. In: Chapman MW, editor. Chapman's orthopaedic surgery. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2001. p.2966-79.
  11. Essex-Lopresti P. The mechanism, reduction technique, and results in fractures of the os calcis. Br J Surg. 1952;39:395-419. https://doi.org/10.1002/bjs.18003915704
  12. Carr JB, Hamilton JJ, Bear LS. Experimental intra-articular calcaneal fractures: anatomic basis for a new classification. Foot Ankle. 1989;10:81-7. https://doi.org/10.1177/107110078901000206
  13. Maxfield JE, McDermott FJ. Experiences with the Palmer open reduction of fractures of the calcaneus. J Bone Joint Surg Am. 1955;37:99-106. https://doi.org/10.2106/00004623-195537010-00012
  14. Buckley RE, Meek RN. Comparison of open versus closed reduction of intraarticular calcaneal fractures: a matched cohort in workmen. J Orthop Trauma. 1992;6:216-22. https://doi.org/10.1097/00005131-199206000-00014
  15. Giachino AA, Uhthoff HK. Intra-articular fractures of the calcaneus. J Bone Joint Surg Am. 1989;71:784-7. https://doi.org/10.2106/00004623-198971050-00028
  16. Kundel K, Funk E, Brutscher M, Bickel R. Calcaneal fractures: operative versus nonoperative treatment. J Trauma. 1996;41:839-45. https://doi.org/10.1097/00005373-199611000-00012
  17. Song KS, Kang CH, Min BW, Sohn GJ. Preoperative and postoperative evaluation of intra-articular fractures of the calcaneus based on computed tomography scanning. J Orthop Trauma. 1997;11:435-40. https://doi.org/10.1097/00005131-199708000-00013
  18. Kim CW, Chung MY, Jung KT, Bae EH, Park SH, Park HK, et al. Comparison of the conservative and operative treatment of the intraarticular calcaneal fractures. J Korean Soc Fract. 1999;12:335-43. https://doi.org/10.12671/jksf.1999.12.2.335
  19. Kim KS, Choi YS, Han SC, Shon KS. Operative treatment of displaced intraarticular fractures of the calcaneus. J Korean Soc Fract. 1998;11:894-9. https://doi.org/10.12671/jksf.1998.11.4.894
  20. Roh JY, Bae SY, Kim SD. Computed tomographic classification and operative treatment of intraarticular calcaneal fractures. J Korean Foot Surg Soc. 2002;6:149-55.
  21. Segal D, Marsh JL, Leiter B. Clinical application of computerized axial tomography (CAT) scanning of calcaneus fractures. Clin Orthop Relat Res. 1985;(199):114-23.
  22. Dooley P, Buckley R, Tough S, McCormack B, Pate G, Leighton R, et al. Bilateral calcaneal fractures: operative versus nonoperative treatment. Foot Ankle Int. 2004;25:47-52. https://doi.org/10.1177/107110070402500202
  23. Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, et al. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2002;84:1733-44. https://doi.org/10.2106/00004623-200210000-00001
  24. Crosby LA, Fitzgibbons T. Computerized tomography scanning of acute intra-articular fractures of the calcaneus. A new classification system. J Bone Joint Surg Am. 1990;72:852-9. https://doi.org/10.2106/00004623-199072060-00009
  25. Crosby LA, Fitzgibbons TC. Open reduction and internal fixation of type II intra-articular calcaneus fractures. Foot Ankle Int. 1996;17:253-8. https://doi.org/10.1177/107110079601700503
  26. Basile A. Subjective results after surgical treatment for displaced intra-articular calcaneal fractures. J Foot Ankle Surg. 2012;51:182-6. https://doi.org/10.1053/j.jfas.2011.10.042
  27. Guyer BH, Levinsohn EM, Fredrickson BE, Bailey GL, Formikell M. Computed tomography of calcaneal fractures: anatomy, pathology, dosimetry, and clinical relevance. AJR Am J Roentgenol. 1985;145:911-9. https://doi.org/10.2214/ajr.145.5.911
  28. Paley D, Hall H. Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors. J Bone Joint Surg Am. 1993;75:342-54. https://doi.org/10.2106/00004623-199303000-00005
  29. Kim WS, Kim KK, Chung WY, Lee WS, Kim YC, Jeon TS, et al. Postoperative evaluation of displaced intra-articular calcaneal fractures by computed tomography. J Korean Fract Soc. 2004;17:249-56. https://doi.org/10.12671/jkfs.2004.17.3.249
  30. Yu X, Pang QJ, Chen L, Yang CC, Chen XJ. Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation: a review. J Int Med Res. 2014;42:17-25. https://doi.org/10.1177/0300060513495626