Association between CT imaging at follow-up and clinical outcomes in heel fractures

Abstract

The reliability of CT data for calcaneal fractures was evaluated, quantifying five CT parameters and investigating their association with clinical outcomes. Fifty-four intra-articular calcaneal fractures surgically treated were considered. Vertical and longitudinal alignment, calcaneal body height, position of sustentaculum tali and subtalar joint congruity were evaluated at 49 months (27-94) follow-up. Each parameter was then quantified and its association with the clinical outcome assessed by the Maryland Foot Score was evaluated. Better clinical outcomes showed a significant association with vertical/longitudinal realignment and with restoration of the calcaneal height. No significant association emerged with reconstruction of the thalamic joint facet congruity. Three-dimensional reconstruction of the calcaneus, in terms of vertical and longitudinal alignment, restoration of the height of the heel body even irrespective of a perfect joint congruity, seems today to be the main goal of the treatment.

Prognostic Value of Computed Tomography Classification Systems for Intra-articular Calcaneus Fractures

“…Studies assessing outcomes of calcaneus fractures are difficult to compare because of the multiple outcome instruments used in previous studies. 1,8,9,[12][13][14][15] The Maryland Foot Score and the Creighton-Nebraska Health Assessment both have been used to measure outcomes in previous studies assessing CT classification systems. 3,22 Howard and colleagues used the SF-36 as an outcome instrument in their recent prospective randomized study.…”

Comment to the paper “Balloon reduction and cement fixation in intra-articular calcaneal fractures: a percutaneous approach to intra-articular calcaneal fractures” by Jacquot et al.

“…We agree that not only is articular reduction important in joint-depression calcaneal fractures, but restoration of the height and shape of the os calcis is mandatory, as pointed out by other authors [2]. This is why we used not only the balloon technique but other restorative measures, such as lateral compression and temporary plantar cortical wire fixation, to help reduce the bone percutaneously.…”

Systematic CT evaluation of reduction and hardware positioning of surgically treated calcaneal fractures: a reliability analysis

“…They found better reduction of the posterior facet and better reduction of the calcaneocuboid joint to be prognostic factors of functional outcome, but did not provide data on reliability of their measurements. In 2010, Magnan et al performed postoperative CT analysis of 54 patients with calcaneal fractures using the Score Analysis of Verona (SAVE) [ 4 , 25 ]. The SAVE scoring system was specifically designed for CT evaluation of calcaneal fractures and describes five displacement parameters [ 4 , 25 ].…”

“…In 2010, Magnan et al performed postoperative CT analysis of 54 patients with calcaneal fractures using the Score Analysis of Verona (SAVE) [ 4 , 25 ]. The SAVE scoring system was specifically designed for CT evaluation of calcaneal fractures and describes five displacement parameters [ 4 , 25 ]. After a mean follow-up of 49 months, parts of the score showed statistical correlation with the clinical outcome as judged by the Maryland Foot Score: better clinical outcomes showed a significant association with vertical/longitudinal realignment and restoration of the calcaneal height [ 25 ].…”

“…The SAVE scoring system was specifically designed for CT evaluation of calcaneal fractures and describes five displacement parameters [ 4 , 25 ]. After a mean follow-up of 49 months, parts of the score showed statistical correlation with the clinical outcome as judged by the Maryland Foot Score: better clinical outcomes showed a significant association with vertical/longitudinal realignment and restoration of the calcaneal height [ 25 ]. Despite its correlation with clinical outcome, data on the reliability of the SAVE scoring system is currently unavailable.…”