Open Reduction for Intra-articular Calcaneal Fractures: Evaluation Using Computed Tomography

Kurozumi, Taketo; Jinno, Yasushi; Satô, Tôru; Inoue, Hajime; Aitani, Tetsuro; Okuda, Kazuhiro

doi:10.1177/107110070302401214

Cited by 59 publications

(49 citation statements)

References 32 publications

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“…1 It is well accepted that multiplanar CT scanning is superior to 2D imaging for imaging the articular surface of many joints. [7][8][9][10][11][12][13][14][15] It is mainly this reason that preoperative CT scans have become standard protocol in articular fractures, such as in the acetabulum, tibial plateau, tibial plafond, and calcaneus. 6,8,16 The recent introduction of a mobile C-arm unit (Iso-C3D, Siemens, Erlangen Germany) has made intraoperative 3D imaging possible.…”

mentioning

confidence: 99%

Intraoperative 3D Imaging: Value and Consequences in 248 Cases

Kendoff

Citak

Gardner

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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mentioning

confidence: 99%

Intraoperative 3D Imaging: Value and Consequences in 248 Cases

Kendoff

Citak

Gardner

et al. 2009

Journal of Trauma: Injury, Infection &Amp; Critical Care

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“…Although the predictive value of Böhler's angle on outcome remains a subject of debate, the initial angle at the time of trauma still guides treatment [5,6]. There is a considerable amount of literature on the change of Böhler's angle following surgically treated displaced intra-articular calcaneal fractures throughout the followup (Table 1) [7][8][9][10][11][12][13][14][15][16][17]. Data on Böhler's angle in conservatively-treated fractures, however, are limited.…”

Section: Introductionmentioning

confidence: 99%

The fate of Böhler’s angle in conservatively-treated displaced intra-articular calcaneal fractures

Bakker

Halm

Lieshout

et al. 2012

International Orthopaedics (SICOT)

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Purpose Although the predictive value of Böhler's angle on outcome remains subject of debate, the initial angle at the time of trauma still guides treatment. Changes in Böhler's angle during follow-up are frequently reported following surgical treatment of displaced intra-articular calcaneal fractures (DIACF). The aim of the present study was to determine the changes in Böhler's angle as a measure of secondary fracture displacement following conservative management of DIACF. Methods Thirty-eight patients with a total of 44 displaced intra-articular calcaneal fractures treated conservatively with a minimum of two lateral radiographs during follow-up were analysed. Böhler's angle at different follow-up times was measured by three observers. The change in angle was compared with the angle at trauma, and influence of trauma mechanism and common calcaneal fracture classifications were determined. Results The results showed a significant decline over time of the Böhler's angle in conservatively-treated patients of more than 11°on average at a mean follow-up of 29.2 weeks. This decrease was not related to gender, the initial angle, or the Essex-Lopresti or Sanders classification. A statistically significantly higher decrease was detected in high energetic trauma compared with low energetic trauma. Conclusion The conservative treatment of displaced intraarticular calcaneal fractures is still a viable option, yet a significant secondary displacement in time should be taken into account, as reflected in a decrease of Böhler's angle of 11°up to one year following trauma.

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“…In addition, in the majority of studies, the accuracy of posterior facet reduction was evaluated using Böhler's and Gissane's angles in plain radiographs. However, Böhler's angle does not reflect degree of facet reduction and are irrelevant to clinical results in studies that compare plain radiographs with CT to evaluate degree of calcaneus fracture reduction,2426 although there is still controversy. Furthermore, the only significant factors found to be related to clinical results in these studies was degrees of reduction of posterior facet and calcaneocuboid joint as determined by CT 24.…”

Section: Discussionmentioning

confidence: 99%

“…However, Böhler's angle does not reflect degree of facet reduction and are irrelevant to clinical results in studies that compare plain radiographs with CT to evaluate degree of calcaneus fracture reduction,2426 although there is still controversy. Furthermore, the only significant factors found to be related to clinical results in these studies was degrees of reduction of posterior facet and calcaneocuboid joint as determined by CT 24. Although CT is essential for the evaluation of posterior facet reduction after surgery, a few studies have evaluated the accuracy of reduction status by immediately postoperative CT after surgery using the sinus tarsi approach 18.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, Böhler's angles, which were measured preoperatively, immediately postoperatively, and last followup, of the S-pin and screw groups were also compared. CT with multiplanar reconstruction was checked preoperatively, immediately postoperatively, and at 12 months after surgery to assess posterior facet reduction, which was evaluated in terms of articular step, defect, and angulation, as described by Kurozumi et al 24. [Table 2].…”

Section: Methodsmentioning

confidence: 99%

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Surgical Treatment of Sanders Type 2 Calcaneal Fractures Using a Sinus Tarsi Approach

Park

Lee

2017

IJOO

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Background:Calcaneum is the most commonly fractured tarsal bone. The optimal treatment for displaced calcaneus fractures involving the posterior facet is surgical. The extensile lateral approach is commonly preferred because it provides sufficient exposure of the subtalar facet. However, this technique has the risk of complications such as wound necrosis and sural nerve injury. Various minimally invasive approaches, such as sinus tarsi approach, limited posterior approach, and percutaneous approach, have been introduced to reduce possible complications. This study was prospectively performed to evaluate the results of the sinus tarsi approach for Sanders Type 2 calcaneal fractures using postoperative computed tomography (CT).Materials and Methods:Between October 2012 and December 2013, 20 Sanders Type 2 calcaneal fractures were consecutively treated using a sinus tarsi approach and checked using CT preoperatively, immediately postoperatively, and at 12 months after surgery. Clinical evaluations were performed using the visual analog scale (VAS) and the ankle-hindfoot score developed by the American Orthopaedic Foot and Ankle Society (AOFAS). Radiographic evaluations were performed using calcaneus lateral and axial radiographs, hindfoot alignment radiograph, and CT. Changes in Böhler's angles and calcaneal widths were evaluated both preoperatively and at last followup. Reduction of the posterior facet was graded according to articular step, defect, and angulation of the posterior facet in CT.Results:VAS and AOFAS scores were significantly improved at 1 year after surgery but did not improve further. Böhler's angles and calcaneal widths were significantly improved after surgery. Böhler's angle was significantly smaller at the last followup than immediately after surgery, whereas calcaneal width was maintained. Reduction of the posterior facet was graded excellent in five feet (25%), good in ten (50%), and fair in five (25%) on immediately postoperative CT. Two feet (10%) had transient sural nerve injury which resolved within 3 months. Five feet (20%) had subfibular pain due to a prominent screw heads.Conclusion:Surgical management using a sinus tarsi approach produced good clinical and radiographic results and low wound complications for Sanders type 2 calcaneal fractures. It is important to have stable fixation and to achieve sufficient reduction of calcaneal width for the prevention of loss of reduction and lateral subfibular impingement.

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Open Reduction for Intra-articular Calcaneal Fractures: Evaluation Using Computed Tomography

Cited by 59 publications

References 32 publications

Intraoperative 3D Imaging: Value and Consequences in 248 Cases

Intraoperative 3D Imaging: Value and Consequences in 248 Cases

The fate of Böhler’s angle in conservatively-treated displaced intra-articular calcaneal fractures

Surgical Treatment of Sanders Type 2 Calcaneal Fractures Using a Sinus Tarsi Approach

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