The value of the axial view in assessing calcaneal fractures

Utukuri, M. M.; Knowles, David; Smith, Kevin L.; Barrie, J.L.; Gavan, Duncan

doi:10.1016/s0020-1383(99)00303-4

Cited by 11 publications

(14 citation statements)

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“…These have proved useful in visualising the extent of the fracture lines in the posterior facet after trauma, but almost all have been replaced by computed tomography (CT) in the last two decades [4]. After the implementation of CT scanning the usefulness of the standard radiographic projections was questioned, for example the need for an axial view [5]. Besides the different plain radiographic projections, various angles and distances were determined in the lateral and axial view.…”

Section: Introductionmentioning

confidence: 99%

Radiographic evaluation of calcaneal fractures: to measure or not to measure

2007

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Objective The aim of this study was to correlate the functional outcome after treatment for displaced intraarticular calcaneal fracture with plain radiography. Design The design was a prognostic study of a retrospective cohort with concurrent follow-up. Patients A total of 33 patients with a unilateral calcaneal fracture and a minimum follow-up of 13 months participated. Patients filled in three disease-specific questionnaires, graded their satisfaction and the indication for an arthrodesis was noted. Standardised radiographs were made of the previously injured side and the normal (control) side. Different angles and distances were measured on these radiographs and compared with values described in the literature. The differences in values in angles and distances between the injured and uninjured (control) foot were correlated with the outcome of the questionnaires, and the indication for an arthrodesis. Results None of the angles correlated with the diseasespecific outcome scores. Of the angles only the tibiotalar angle correlated with the VAS (r=0.35, p=0.045) and only the absolute foot height correlated with the indication for an arthrodesis (odds=0.70, CI=0.50-0.99). Conclusion In this study the radiographic evaluation correlated poorly with the final outcome. Measurements on plain radiographs seem not to be useful in determining outcome after intra-articular calcaneal fractures.

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Section: Introductionmentioning

confidence: 99%

Radiographic evaluation of calcaneal fractures: to measure or not to measure

2007

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“…However, some researchers suggested that the calcaneal axial radiography may be valueless because this radiography poses additional radiation to the patient and was difficult to obtain in routine evaluation and diagnosis of calcaneal fractures 14 . Zhang et al 3 conducted a study to test the value of axial view in diagnosing calcaneal fracture by introducing an angle Z, and their study confirmed that calcaneal axial radiography is useful in diagnosing patients with suspected calcaneal fracture, especially in distinguishing intra-articular fractures and selection for computed tomographic scan.…”

Section: Discussionmentioning

confidence: 99%

Value of modified axial review radiograph in diagnosing calcaneal fractures

Guo

Han

et al. 2020

Sci Rep

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To investigate the value of modified calcaneal axial radiograph-the horizontal calcaneal axial radiograph in diagnosing calcaneal fractures, patients who had acute calcaneal fractures or internal fixation were enrolled, and three groups were established, including the acute fracture group (n = 20), the internal fixation group (n = 20), and the healthy control group (n = 20). All the subjects had regular and modified calcaneal axial radiograph for comparison. In analysis of the results, all volunteers could have ankle dorsiflexion at different degrees. When the ankle was at 30º dorsiflexion for regular axial radiograph, the subtalar joint and the sustentaculum tali could not be clearly displayed. The calcaneus was elongated if the tube tilted in a larger angle but shortened if the tube titled in a smaller angle. When the ankle was at neutral (0º dorsiflexion) location with the tube tilting 45° cephalad or when the ankle was at 20° plantarflexion with the tube tilting 35° cephalad, the subtalar joint, sustentaculum tali, calcaneal body and internal and external calcaneal processes could all be clearly demonstrated. No significant difference (P = 0.79) existed in displaying the bony anatomical structures in regular compared with modified calcaneal axial radiography. For patients with acute calcaneal factures or with internal fixation, the modified calcaneal axial radiography could display more significantly clearly (P = 0.001) bony anatomical structures than the regular one. In conclusion, the modified calcaneal axial radiograph can be performed easily and can clearly show the bony structure of the calcaneus and surrounding bones without adding pain to the patients with calcaneal fractures. In assessing calcaneal fractures with plain radiographs, surgeons usually use lateral and axial views for the diagnosis and treatment 1,2 , especially the axial view of plain radiographs 3. Zhang et al. 3 have studied the important role of the axial radiograph of calcaneus in diagnosing calcaneal fractures and found that the axial view is very useful in diagnosing patients with suspected calcaneal fracture especially in distinguishing intra-articular fractures. Using the axial plain radiograph of the calcaneus, Soeur and Remy 4 even classified the calcaneal intra-articular fractures into three types: first-degree fractures being nondisplaced shear fractures with widening of the joint surface, second-degree including secondary fracture lines with a minimum of three pieces, and third-degree being highly comminuted. When taking axial radiographs of the calcaneus, the ankle is placed in maximum dorsiflexion so as to better demonstrate the calcaneal talus process, subtalar joint, calcaneal body, medial and lateral processes and other anatomical relationship. However, for patients with acute calcaneal fractures or internal fixation in calcaneal fractures, the ankle joint is limited in dorsiflexion/range due to pain, soft tissue swelling and some hemarthros, which will affect the calcaneal axial view radiography to clearly show the calc...

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“…Overlooking an intra-articular fracture sometimes bring about conservative treatment to patients who should receive surgical procedure or proceed to CT scan. Utukuri et al [ 11 ] reported in a previous study that the axial view does not appear to add sufficiently to the diagnosis and evaluation of calcaneal fractures. The different results may due to increased sample size, random procedure and prolonged interval between two assessments in our study.…”

Section: Discussionmentioning

confidence: 99%

“…X-ray plain film is obviously easy to gain than intra-operative CT scan during operation even if in highly specialized and fully equipped trauma centre. Extra radiation dosage can also be avoided if patients can be treated with plain radiographs rather than proceed to CT examination [ 11 ], furthermore, operation time and infection risk should also be decreased. Although if available, a CT scan and 3D reconstruction is still the most precise way to evaluate calcaneal fractures.…”

Section: Discussionmentioning

confidence: 99%

“…However, with the development of imaging technology, some believe axial view can be abandoned for its useless to diagnosis and treatment, since what can gain from axial view can also be gained from CT scans and even better [ 10 ]. Utukuri et al [ 11 ] suggested in a research paper that axial view requires an additional radiation dosage and is difficult and painful to obtain, while not adding significant value to the evaluation and diagnosis of calcaneal fractures to be routinely requested. Does axial view still has an unique role in current treatment process of calcaneal fractures or just an out of fashion technique which should be abandoned?…”

Section: Introductionmentioning

confidence: 99%

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Does axial view still play an important role in dealing with calcaneal fractures?

Tao

Chen

et al. 2015

BMC Surg

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BackgroundThe study aimed to analyze the role of axial view in different phases of treatment and demonstrate whether axial view is still useful in evaluating the calcaneal fractures.Methods156 patients with suspected unilateral calcaneal fractures were enrolled in the study, axial and lateral view of the affected foot and single axial view of the unaffected foot were gained. 16 were excluded due to unsatisfying axial radiograph. The remain 140 patients were eventually included into the study. Two separate assessments were conducted on two occasions with a three weeks interval to diagnose fractures. Lateral views were assessed firstly, and lateral combined with axial views were assessed three weeks later. Each of the 140 sets was evaluated by one of 6 surgeons randomly. Sensitivity and specificity value were compared between the two assessments. A new value Z which can directly reflect the degree of bulge on the calcaneal lateral wall on the axial view were introduced into the study. Z value of the 140 unaffected feet were measured. Data of another group of 31 patients who confirmed their lateral hindfoot pain caused by widening of calcaneus was reviewed. Liner regression was employed to analyze the relationship between angle Z and the severity of lateral pain.ResultsAccording to the two assessments, without axial view, specificity value will be significantly lower in diagnosing calcaneal fractures (p = 0.024) and sensitivity value will be significantly lower in distinguishing intra-articular fractures (p < 0.001). The normal threshold of angle Z was estimated from 98.06° to 100.64° (p <0.001). Liner regression shows that the lateral hindfoot pain will obviously aggravate along with the increasing of angle Z value (p <0.001).ConclusionsAxial view is useful in diagnosing a patient with suspected calcaneal fracture especially for distinguishing intra-articular fractures and selection for CT scan. With the introduction of angle Z, axial view can get excellent performance in intra-operative assessment as well as in post-operative follow up procedure. Axial view can still play an irreplaceable role in assessing and evaluating calcaneal fractures, and can be employed as an essential reference during surgical procedure .Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-015-0004-6) contains supplementary material, which is available to authorized users.

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The value of the axial view in assessing calcaneal fractures

Cited by 11 publications

References 4 publications

Radiographic evaluation of calcaneal fractures: to measure or not to measure

Radiographic evaluation of calcaneal fractures: to measure or not to measure

Value of modified axial review radiograph in diagnosing calcaneal fractures

Does axial view still play an important role in dealing with calcaneal fractures?

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