Estudo epidemiológico das fraturas do calcâneo em um hospital terciário

Plating technique outcome evaluation in calcaneal fracture based on American orthopaedics foot and ankle score and Böhler-Gissane angle: A case series

Introduction

Intraarticular Calcaneal fracture treatment nowadays is still up for debate. Surgical plating treatment is favorable because of the rapid healing process and better anatomical reduction despite the invasive intervention. Hence, clinical evaluation is needed to assess the quality-of-life index from foot and ankle by the American orthopaedics Foot and Ankle Society (AOFAS) score postoperatively. Then, the outcome evaluation of reduction in calcaneal plating of intraarticular calcaneal fracture with Böhler angle and Gissane angle to see if the calcaneal plating technique is a recommended treatment for the calcaneal fracture.

Methods

We treated six patients from December 2020–July 2021 with a calcaneal fracture that underwent surgical plating, mainly by one surgeon. A calcaneal fracture is classified according to sanders classification. In this study, four patients are above the age of 40, and two are under 25. Pre-operative Böhler angle ranged from 8 to 65°, and Gissane angle ranged from 134 to 158°.

Outcomes

Surgical plating was performed on all six patients. From clinical evaluation using the AOFAS score, we got satisfactory results on all patients who underwent calcaneal plating surgery. Three patients achieved excellent range outcomes with 95% and 99% of AOFAS Scores, and three patients reported AOFAS score good range outcomes with the lowest score of 88%. From the radiological outcome, most of the patient's Böhler and Gissane angles achieved normal value after surgical plating.

Conclusion

The calcaneal plating technique gives better anatomical reduction depending on Bohler and Gissane angle. These results promise that anatomical reduction can improve clinical outcomes based on the AOFAS score. Thus, the plating method can be used effectively to treat an intraarticular calcaneal fracture.

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Limited studies reported the outcome method of “Plating technique” surgery for calcaneal fracture.

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Anatomical reduction achieved with Plating technique

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Satisfactory clinical outcome was concluded after Plating technique surgery for calcaneal fracture.

Different types and epidemiological patterns of calcaneal fractures based on reviewing CT images of 957 fractures

INTRODUCTION

Calcaneal fractures may have lifelong debilitating sequences, if not treated properly. Identifying different types of calcaneal fractures based on the computed tomography (CT) scans can increase our conception about these fractures.

METHODS

In a cross-sectional study, the available CT images of all consecutive patients with the diagnosis of calcaneal fracture, from January 2015 to December 2018, were reviewed to determine different patterns and types of these fractures.

RESULTS

CT images of 886 patients (mean age, 41.29 ± 14.9; range, 3-89 years; male/female, 4.86; pediatric: 3.7%) with 957 calcaneal fractures were evaluated. The peak incidence of calcaneal fractures was seen in patients between 30 to 39 years of age (29%). The rate of open fractures and bilateral involvements were 2.4% and 8.0%, respectively. Among 680 (71.0%) intra-articular calcaneal fractures, subtalar calcaneal fractures were the most common type (94.3%). The majority of intra-articular subtalar calcaneal fractures were displaced (95.0%) with calcaneocuboid joint (CCJ) involvement (59.9%). Fracture lines were extended to the CCJ in about 86.9% of Sanders type IV, 66.3% of type III, and 60.2% of type II. Among 261 extra-articular fractures (27.3%), calcaneal body fracture (55.6%) was the most frequent type, followed by medial tubercle fracture (24.1%), calcaneal tuberosity fracture (10.4%), Degan type I anterior process fractures (5.4%), Degan type II anterior process fracture (3.4%), and isolated lateral tubercle fracture (1.1%). Most of bilateral calcaneal fractures were intra-articular subtalar fractures with involvement of CCJ. Although majority of intra-articular calcaneal fractures were displaced; less than half of the extra-articular fractures were displaced.

CONCLUSION

Displaced intra-articular subtalar calcaneal fractures with CCJ involvement are the most frequent type of unilateral and bilateral calcaneal fractures. It appears that there is a correlation between Sanders type and the probability of CCJ involvement. Unlike intra-articular subtalar calcaneal fractures, the CCJ in the majority of extra-articular calcaneal body fractures was intact.

LEVEL OF EVIDENCE

Level IV.

Intra- and inter-observer reliability of measurements on 3D images of the calcaneus bone

BACKGROUND

The use of the 3D orientation angle of the calcaneal posterior subtalar (PTC) joint facet might be superior to the Böhler's angle to evaluate the quality of reduction after performing an open reduction and internal fixation (ORIF) of displaced intra-articular calcaneal fractures (DIACFs). Methods: Three-Dimensional segmentations of the preoperative, postoperative and uninjured calcaneus of 54 patients with a DIACF were assessed by 4 observers with different medical backgrounds. After the delineating of the PTC on the 3D images, a MeVisLab™ software calculated the 3D orientation angle of the PTC, which was determined as the average of the angles between the normal vectors of the PTC and the main axis of the calcaneus, calculated by principal component analysis. The intraclass correlation coefficient (ICC) was used to determine the intra- and inter-observer reliability. Results: The ICC of the intra-observer measurements varied from 0.699 to 0.890. For the preoperative measurements an inter-observer ICC of 0.828 was calculated. For the postoperative measurements the calculated inter-observer ICC amounted 0.692. The inter-observer ICC of the uninjured measurements amounted 0.776. Discussion: Observation of the PTC on 3D images of the calcaneus shows a good intra- and inter-observer reliability, which means it is safe to use the 3D OAC of the PTC in clinical practice.