Fractures to the anterior process of the calcaneus – Clinical results following functional treatment

Maßen, Felix Kurt; Baumbach, Sebastian Felix; Herterich, Viktoria; Böcker, Wolfgang; Waizy, Hazibullah; Polzer, Hans

doi:10.1016/j.injury.2019.06.008

Cited by 18 publications

(26 citation statements)

References 20 publications

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“…The reported incidence of CCJ involvement in calcaneal fractures varies from 33% to 76% (27). Previous studies have suggested that unsatisfactory reduction of the CCJ might lead to impingement symptoms or lateral peritalar subluxation (28). Therefore, surgeons should be cautious about the management of calcaneal fractures extending into the CCJ in their operative steps.…”

Section: A B C Dmentioning

confidence: 99%

Fracture mapping of complex intra-articular calcaneal fractures

Ni¹,

Lv²,

Sun³

et al. 2021

Ann Transl Med

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Background: Intra-articular calcaneal fracture remains challenging to manage. Computed tomography and fracture mapping are useful for the diagnosis and treatment of calcaneal fractures. The aim of the present study was to characterize calcaneal fracture patterns using fracture mapping.Methods: Sixty-two calcaneal fractures were retrospectively included in the study. For each case, the fracture was simulated reduction manually. The fracture lines and zones of comminution were graphically superimposed onto an intact calcaneal template to identify fracture patterns. Major fracture lines and comminution were assessed by focusing on the posterior joint facet, medial wall, lateral wall, sustentaculum tali, and anterior process.Results: The fracture lines were mostly concentrated on the area anterior to the posterior joint facet and extended medially. The longitudinal lines ran posteriorly from the angle of Gissane, and separated the sustentaculum tali and medial wall from the calcaneal tuberosity. In the lateral wall, the fracture lines extended posteriorly with some branches to the bottom of the calcaneus. No fracture lines passed through the sustentaculum tali. Fracture lines of the posterior tuberosity and anterior process were rare.Conclusions: Calcaneal fracture lines follow characteristic patterns, which are closely related to the bone structure and fracture mechanism. These fracture patterns will aid clinicians choose surgical approach and fixations in the treatment of calcaneal fractures.

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Section: A B C Dmentioning

confidence: 99%

Fracture mapping of complex intra-articular calcaneal fractures

Ni¹,

Lv²,

Sun³

et al. 2021

Ann Transl Med

View full text Add to dashboard Cite

show abstract

“…Previous studies have shown that poor reduction of CCJ can lead to impingement symptoms or lateral peritalar subluxation [35]. Many studies relied on x-rays only and cannot routinely perform CT scans [36]. In the 3D heat maps, the comminution zones were located on the inferior one-third aspect of the medial of the CCJ surface.…”

Section: Discussionmentioning

confidence: 99%

3D Mapping of Intra-articular Calcaneal Fractures

Shi¹,

Zhan²,

W³

et al. 2021

Preprint

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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.

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“…Consequently, there is still missing evidence concerning the optimal therapy regimen in these cases. The fractures are mainly treated conservatively, and only in displaced fractures is operation indicated (8,12,18,19). Overall, studies reported a satisfactory outcome after conservatively or operatively treated extra-articular calcaneal fractures (11,12,20), but inadequately treated tuberosity avulsion fractures can lead to limitations involving the Achilles tendon and, in case of anterior process fractures, to painful non-unions (11).…”

Section: Discussionmentioning

confidence: 99%

“…Calcaneal fractures not involving the subtalar joint are often managed conservatively, and only vertical fractures of the tuberosity, displaced medial process, and large anterior process fractures are treated surgically (11). In contrast to complex intraarticular calcaneal fractures, the overall outcome of operative or non-operative managed process fractures of the calcaneus is satisfactory (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Patient-Reported Outcome Following Operative and Conservative Treatment of Calcaneal Fractures: A Retrospective Analysis of 79 Patients at Short- to Midterm Follow-Up

et al. 2021

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Background: Fractures of the calcaneus are severe injuries of the hindfoot, mostly resulting from high-energy axial loads, which still present enormous challenges to modern trauma surgery. Possible variables influencing the outcome are the type of fracture, age, and quality of fracture reduction. These might also be factors affecting the self-reported patient outcome, but large studies are still lacking. Therefore, the aim of this study was to analyze the patient-reported outcome of calcaneal fractures following operative and conservative treatment.Methods: All patients suffering from calcaneal fractures between 2002 and 2015 were enrolled in this retrospective analysis. The calcaneal fractures were classified according to Sanders and the AO classification system. For further analysis, two groups were formed: group I involved complex intra-articular fractures defined by the involvement of the posterior calcaneal facet, while group II consisted of extra-articular and process calcaneal fractures. Data were collected via the patient registry, radiographs, and a standardized questionnaire (Foot and Ankle Outcome Score, FAOS). For outcome analysis, non-parametric Mann–Whitney U-test was performed, and Spearman's rank correlation coefficient was calculated.Results: In total, the functional outcome of 79 patients with calcaneal fractures was analyzed. In group 1 (n = 43), the mean FAOS score was 65.5 ± 18.9. The surgically treated patients with a Sanders type II calcaneal fracture had a mean FAOS score of 72.9 ± 17.2, type III fractures had 65.6 ± 20.8, and type IV had 61.1 ± 19 (p = 0.15). The reoperation rate was 22%, most frequently caused by wound complications (10%). The mean follow-up time was 64.5 ± 44 months. The mean FAOS score of group 2 (n = 36) was 75.2 ± 18.4, and 83% of the patients (=30) were managed conservatively. Only one out of six operatively managed patients had a reoperation due to regular implant removal. The mean follow-up time was 31 ± 25.9 months.Conclusion: Intra-articular calcaneal fractures are severe injuries of the hindfoot leading to a fair to poor functional outcome in the majority of the patients. Complications regarding wound healing are the most common causes for revisional surgery. Extra-articular calcaneal fractures are a heterogenous entity commonly managed non-operatively. Overall, they show a better functional outcome in comparison to intra-articular calcaneal fractures.

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Fractures to the anterior process of the calcaneus – Clinical results following functional treatment

Cited by 18 publications

References 20 publications

Fracture mapping of complex intra-articular calcaneal fractures

Fracture mapping of complex intra-articular calcaneal fractures

3D Mapping of Intra-articular Calcaneal Fractures

Patient-Reported Outcome Following Operative and Conservative Treatment of Calcaneal Fractures: A Retrospective Analysis of 79 Patients at Short- to Midterm Follow-Up

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