Role of computerised tomography in management of intra-articular fractures of the os calcis

Abstract

This study aimed to look at the role played by the CT scan in decision making in the management of intraarticular fractures of the calcaneum. Twenty-four patients with intra-articular fractures of the calcaneum were included. Their initial radiographs and CT films were blinded and assessed by three independent observers. Based on this they were selected for operative or non-operative management. The actual management was also recorded. The data were then subjected to statistical analysis to look at the association between the decision from radiograph, that from the CT scan and the actual management undertaken. Non-parametric tests for related samples were performed to look at the association between the actual management and the decisions made by assessing the radiographs and the CT scans. For all three observers, there was no significant difference between the actual management and decisions made by assessing the plain radiographs or the CT scan. There was also no significant difference between the radiograph-based and the CT-based decisions. However, the Cochran Q test showed that there was significant variation among the three observers for the CT-based assessment. Our results, show that the CT scan should only be done when a definite decision is made to operate on a patient, based on plain radiographs. Calcaneal fractures which are selected for non-operative management, based on X rays, should not have a CT scan as a routine as it provides no valuable additional information affecting the management decision.

An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures

“…Typical findings of calcaneal malunion are subtalar arthritis due to posterior facet and calcaneocuboid joint incompatibility, heel widening and sub-fibular impingement of the peroneal tendons due to expansion of the lateral calcaneal wall, reduction of ankle dorsiflexion due to decrease in calcaneal height and hindfoot malalignment and varus deformity due to displaced calcaneal tuberosity. 9,24 This study supports the surgical treatment of displaced calcaneal fractures with open reduction and internal fixation.…”

Is arthroscopic assisted percutaneous screw fixation as good as open reduction and internal fixation for the treatment of displaced intra-articular calcaneal fractures?

“…Kumar et al reported that CT scans are not compulsory to determine the need for surgery [7]. Broden views in different angles give valuable information regarding the congruency of the posterior facet of the subtalar joint [1].…”

“…In recent years, there is increased understanding of the pathoanatomy of the fracture [5][6][7]. Non operative treatment, while avoiding the wound issues associated with surgery, results in the fracture being not reduced, malaligned and may cause a bad outcome because of peroneal tendon dislocation, subtalar joint dysfunction, and a non anatomic tuberosity causing disrupted foot mechanics.…”

Os calcaneus angles in dry bones of Turkish population

“…The determination of the treatment process is linked to the diagnosis and severity of the fracture. In recent years computed tomography (CT) has been used instead of radiographic methods [27][28][29][30][31] . In calcaneal fractures detailed evaluation of pathoanatomy with CT demonstrating the integrity of the joint surfaces and better understanding of the mechanisms of fracture formation have led to progress in classification and treatment.…”