Classifications in Brief: Sanders Classification of Intraarticular Fractures of the Calcaneus

Liang

The Journal of Foot and Ankle Surgery

et al. 2022

Background: Several primary fracture classification systems (FCSs) have been widely used for intra-articular calcaneal fractures. The purpose of this study was to measure the inter-and intra-observer variations as well as integrality of the Zwipp, Crosby-Fitzgibbons, Sanders, and Eastwood-Atkins classification systems based on more accurate CT scans.Methods: 549 patients with intra-articular calcaneal fractures taken from a database in our level-I trauma centre (3 affiliated hospitals) were included from January 2018 to December 2019. For each case, normative CT (1 mm slices) scans were available.Four different observers reviewed all CT scans two times according to these 4 most prevalent FCSs within a 2-month interval. For these four FCSs, the kappa [κ] coefficient was used to evaluate interobserver reliability and intraobserver reproducibility, and the percentage that can be classified was used to indicate integrality. Results:The κ values were measured for Zwipp (κ= 0.38 interobserver, κ= 0.61 intraobserver), Crosby-Fitzgibbons (κ= 0.48 interobserver, κ= 0.79 intraobserver), Sanders (κ= 0.40 interobserver, κ= 0.57 intraobserver), and Eastwood-Atkins (κ= 0.44 interobserver, κ= 0.72 intraobserver). Furthermore, the integrality were calculated for Zwipp (100 %), Crosby-Fitzgibbons (100 %), Sanders (92 %) as well as Eastwood-Atkins (89.6 %). Conclusion:Compared with previous literatures, CT scanning with higher accuracy can significantly improve intraobserver reproducibility of Zwipp and Eastwood-Atkins FCSs, but it has no positive effect on variability of Sanders FCS and interobserver reliability of Crosby-Fitzgibbons FCS. While in terms of integrality, Zwipp and Crosby-Fitzgibbons FCSs appear to be superior to the other two FCSs.

Section: Discussionmentioning

confidence: 99%

CT-Based Classification Systems for Intra-Articular Calcaneal Fractures: The Inter- and Intraobserver Variations as well as Integrality

Liang

The Journal of Foot and Ankle Surgery

et al. 2022

“…Following CI, microglial activation occurs that leads to significantly increased aggregation of inflammatory cells and secretion of cytokines, with concurrent induction of acute neuroinflammation triggered by neuronal hypoxia within brain tissues. In various in vitro experiment models, inflammatory factors, such as TNF-α, IL-1β, and IL-6, have been shown to be associated with CI-induced brain injury ( Hovhannesyan and Hovhannisyan, 2019 ; Jimenez-Almonte et al, 2019 ). In accordance with the results of previous studies, the results of this study revealed that the levels of inflammatory factors, including TNF-α, IL-1β, and IL-6, were significantly reduced by TMGT treatment.…”

Section: Discussionmentioning

confidence: 99%

Underlying Mechanism and Active Ingredients of Tianma Gouteng Acting on Cerebral Infarction as Determined via Network Pharmacology Analysis Combined With Experimental Validation

et al. 2021

Cerebral infarction (CI), a common cerebrovascular disease worldwide, is caused by unknown factors common to many diseases, including hypokalemia, respiratory diseases, and lower extremity venous thrombosis. Tianma Gouteng (TMGT), a traditional Chinese Medicine (TCM) prescription, has been used for the clinical treatment of CI. In this study, high-performance liquid chromatography (HPLC) fingerprint analysis was used to detect and identify major chemical constituents of TMGT. TCMSP and BATMAN-TCM databases were used to screen for active TMGT constituent compounds, while the GeneCards database was used to screen for protein targets associated with CI. Next, GO and KEGG enrichment analysis of these core nodes were performed to determine the identities of key associated biological processes and signal pathways. Meanwhile, a total of six possible gene targets of TMGT, including NFKBIA, PPARG, IL6, IL1B, CXCL8, and HIF1A, were selected for further study using two cellular models of CI. For one model, PC12 cells were treated under oxygen and glucose deprivation (OGD) conditions to generate an OGD cellular model of CI, while for the other model, BV2 cells were stimulated with lipopolysaccharide (LPS) to generate a cellular model of CI-associated inflammation. Ultimately TMGT treatment increased PPARγ expression and downregulated the expression of p-P65, p-IκBα, and HIF-1α in both OGD-induced and LPS-induced cell models of CI. In addition, molecular docking analysis showed that one TMGT chemical constituent, quercetin, may be a bioactive TMGT compound with activity that may be associated with the alleviation of neuronal damage and neuroinflammation triggered by CI. Moreover, additional data obtained in this work revealed that TMGT could inhibit neuroinflammation and protect brain cells from OGD-induced and LPS-induced damage by altering HIF-1α/PPARγ/NF-κB pathway functions. Thus, targeting this pathway through TMGT administration to CI patients may be a strategy for alleviating nerve injury and neuroinflammation triggered by CI.

“…In 1993, based on coronal and axis, CT images of the Sanders classification are the most used system for classifying ICFs [38], subdividing into four types, depending on the number of fractures and the position of fracture lines at the posterior calcaneal facet [5]. Despite its being widely used, the value of this classification is always disputed due to its limited reliability and validity [39]. This system does not consider fracture displacement in the sagittal or axial plane relative to the widest undersurface of the posterior talar articular surface and the pathological changes of calcaneal fractures.…”

Section: Discussionmentioning

confidence: 99%

3D Mapping of Intra-articular Calcaneal Fractures

Shi¹,

Zhan²,

W³

et al. 2021

Preprint

Background: The management of intra-articular calcaneal fractures (ICFs) still faces a challenge. Available research about the anatomic patterns of ICFs is lacking. We aimed to define the pattern of ICFs by a three-dimensional (3D) mapping and determine whether there are consistent fracture patterns and comminution zones. Methods: 67 patients of ICFs with available computed tomographic (CT) scans were identified. The calcaneal fractures fragments on CT were multiplanar reconstructed and virtually reduced. 3D heat mapping was subsequently created by graphically superimposing all fracture lines onto a standard calcaneal template. Mapping of fracture lines and comminution zones in both the axial and sagittal planes were performed. Results: The cohort included 26 (38.8%) left calcaneal fractures, 27 (40.30%) right calcaneal fractures, and 14 (20.9%) cases with bilateral fractures. Comminuted fractures accounted for 92.5% of all fractures. Sagittal 3D mapping demonstrated that fracture lines were concentrated in the critical angle of Gissane and extended posteriorly to the rear of the tuberosity of the lateral wall and the anterior of the medial process of the calcaneus tuberosity but with more significant variation in the medial wall. The mean angle of fracture lines concerning the long axis of the calcaneal (LAC) was 29.1°and 19.2° in the lateral wall and medial wall, respectively. Axial 3D mapping demonstrated that fracture lines were primarily concentrated in the area anterior to the posterior joint facet and extended along the posterior joint facet and calcaneus sulcus to the posteriorly of the tuberosity. The mean angle of fracture lines concerning the LAC was 11° in the axial wall. 3D mapping demonstrated that the comminution zones are closely related to the internal structure and fracture mechanism. Conclusion: The data presented have elucidated there are consistent characteristic fracture patterns and comminution zones for ICFs. This study provides visual guidelines to understand fracture morphology, which may assist with fracture classification, preoperative planning, fixation concepts development, and internal structure analysis.