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Abstract
Purpose
We attempt to evaluate the significance of calcaneal posterior tuberosity fragment reduction when treated with surgical open reduction in displaced intra-articular calcaneal fractures.
Materials and Methods
A total of 90 patients with displaced intra-articular calcaneal fracture, between January 2010 and December 2015, treated with open reduction and internal fixation were enrolled in this study. At postoperative 3 months, we evaluated the reduction state of calcaneal posterior tuberosity fragment by measuring the degree of lateral displacement of the posterior tuberosity fragment on the calcaneal axial view. Moreover, we also evaluated the difference in the calcaneal length and height with the uninjured side on the lateral view of both sides. In addition, we estimated the reduction state of the posterior facet by measuring the degree of gap and step-off on the semi-coronal view of postoperative computed tomography and estimated the restoration of calcaneal angle by measuring the difference in Böhler's and Gissane angle with the uninjured side on the lateral view of both sides.
Results
The correlation coefficient with 3 components for evaluating the reduction state of posterior tuberosity fragment and gap and step-off of posterior facet was r=0.538, 0.467, r=0.505, 0.456, r=0.518, and 0.493, respectively, and restoration of Böhler's and Gissane angle was r=0.647, 0.579, r=0.684, 0.630, r=0.670, and 0.628, respectively. The relationship of each component shows a significant correlation as all p-values were <0.01.
Figures and Tables
Fig. 1
A 57-year-old male patient, with a Sanders type III intra-articular calcaneal fracture, was treated using open reduction and internal fixation with the extensile lateral approach. (A) Preoperative x-ray and computed tomography (CT) scans. (B) Postoperative x-ray and CT scans showed inaccurate reduction of posterior tuberosity fragment (yellowish arrow line), posterior facet step-off (yellowish circle), and collapsed Böhler's angle (yellowish line).
Fig. 2
The degree of lateral displacement of the posterior tuberosity fragment (a) is measured as the gap between the superomedial fragment and posterior tuberosity fragment on the medial aspect of the calcaneal axial view.
Fig. 3
The difference in the calcaneal length with the uninjured side (b-b') is measured from the most posterior point of the tuberosity to the calcaneocuboid joint on the lateral view.
Fig. 4
The difference in the calcaneal height with the uninjured side (c-c') is measured as a perpendicular distance from the most superior part of the posterior facet to the inferior aspect line between the calcaneocuboid joint and posterior tuberosity on the lateral view.
Fig. 5
The relationship between the degree of lateral displacement of the posterior tuberosity fragment and gap/step-off of posterior facet and restoration of Gissane angle/Böhler's angle shows a significant correlation (p<0.01).
Fig. 6
The relationship between the difference in calcaneal length with uninjured side and gap/step-off of posterior facet and restoration of Gissane angle/Böhler's angle shows a significant correlation (p<0.01).
Fig. 7
The relationship between the difference in the calcaneal height with the uninjured side and gap/step-off of posterior facet and restoration of Gissane angle/Böhler's angle shows a significant correlation (p<0.01).
Fig. 8
The primary fracture line (yellowish line) produced two large fragments, SM, and posterolateral fragment (SL and PT). AL: Anterolateral fragment, SL: Superolateral fragment, SM: Superomedial fragment, PT: Posterior tuberosity fragment.
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