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

Joon-Sang Eom; Young-Deuk Joo; Seong-Jun Kim; Min-Ho Shin; Dong-Oh Lee; Hong-Geun Jung

doi:10.14193/jkfas.2014.18.4.165

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Eom, Joo, Kim, Shin, Lee, and Jung: Correlation Analysis of Reduction for Intra-Articular Calcaneal Fracture and Clinical Outcomes Using Postoperative Computed Tomography

Original Article

J Korean Foot Ankle Soc 2014;18(4):165-172.

Published online: 19 January 2014

DOI: https://doi.org/10.14193/jkfas.2014.18.4.165

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

Joon-Sang Eom, Young-Deuk Joo, Seong-Jun Kim^*, Min-Ho Shin^†, Dong-Oh Lee, Hong-Geun Jung

Department of Orthopaedic Surgery, Konkuk University School of Medicine, Seoul, Korea

^*The Armed Forces Yangju Hospital, Yangju, Korea

^†LCT Hospital, Suwon, Korea

Corresponding Author: Hong-Geun Jung Department of Orthopaedic Surgery, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-729, Korea Tel: 82-2-2030-7609, Fax: 82-2-2030-7369, E-mail: jungfoot@hanmail.net

Received 30 June 201425 October 2014 Accepted 26 October 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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, BÖhler 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±8.5 and 2.2±2.2. Subjective satisfaction was excellent in 15 cases, good in 19 cases, and fair in seven cases. The average BÖhler angle was restored from 11.1° to 24.7° (p<0.05), Gissane angle was changed from 121.0° to 119.0° (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, BÖhler 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 BÖhler angle and Gissane angle but did show correlation with anatomical reduction of the posterior facet joint.

Keywords: Calcaneal fracture, Articular step-off, Articular gap, Computed tomography

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Figure 1.

The radiographs show preoperative Gissane angle (A), postoperative Gissane angle (B), preoperative Böhler angle (C), and postoperative Böhler angle (D).

Figure 2.

Preoperative (A) and postoperative (B) axial radiographs show fracture width. Fracture width is measured as the widest part of calcaneus.

Figure 3.

Computed tomographic images show preoperative articular gap (A, arrow), postoperative articular gap (B, arrow), preoperative articular step-off (C, arrow), and postoperative articular step-off (D, arrow) in the intra-articular calcaneal fracture.

Table 1.

Correlation Analysis of Postoperative Articular Step-off and Articular Gap with Clinical Outcomes

Group	Foot	VAS score	AOFAS score
Step-off ≥2 mm	22	3.0±2.4	81.1±9.6
<2 mm	19	1.3±1.7	87.1±6.2
Gap ≥2 mm	33	2.4±2.2	82.7±8.7
<2 mm	8	1.50±2.1	88.7±6.9

Values are presented as number or mean±standard deviation. VAS: visual analogue scale, AOFAS: American Orthopaedic Foot and Ankle Society.

Table 2.

Correlation Analysis of Clinical Outcome and Sanders Classification

Sanders classification	Foot	VAS score	AOFAS score
II	7	2.3±1.6	87.8±7.6
III	25	2.3±2.5	82.7±9.6
IV	9	2.0±2.1	84.4±5.8

Values are presented as number or mean±standard deviation. VAS: visual analogue scale, AOFAS: American Orthopaedic Foot and Ankle Society.

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