Open Access, Peer-reviewed, Quarterly
pISSN 1225-1682
eISSN 2287-9293
    J Korean Fract Soc. 2016 Oct;29(4):233-241. Korean.
    Published online Oct 20, 2016.
    https://doi.org/10.12671/jkfs.2016.29.4.233
    Copyright © 2016 The Korean Fracture Society. All rights reserved.
    Original Article

    The Significance of Calcaneal Posterior Tuberosity Fragment Reduction When Treated with Open Reduction in Displaced Intra-Articular Calcaneal Fractures

    Hong-Ki Park, M.D., Jong-Ryoon Baek, M.D., Jang-Seok Choi, M.D., Sang-Jin Lee, M.D. and Je-Won Paik, M.D.
      • Department of Orthopedic Surgery, Gachon University Gil Medical Center, Incheon, Korea.
    • Address reprint requests to: Hong-Ki Park, M.D. Department of Orthopedic Surgery, Gachon University Gil Medical Center, 21 Namdong-daero 774beon-gil, Namdong-gu, Incheon 21565, Korea. Tel: 82-32-460-3384·Fax: 82-32-423-3384, Email: phk@gilhospital.com
    Received May 10, 2016; Revised June 08, 2016; Accepted July 01, 2016.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    We attempt to evaluate the significance of calcaneal posterior tuberosity fragment reduction when treated with surgical open reduction in displaced intra-articular calcaneal fractures.

    Materials and Methods

    A total of 90 patients with displaced intra-articular calcaneal fracture, between January 2010 and December 2015, treated with open reduction and internal fixation were enrolled in this study. At postoperative 3 months, we evaluated the reduction state of calcaneal posterior tuberosity fragment by measuring the degree of lateral displacement of the posterior tuberosity fragment on the calcaneal axial view. Moreover, we also evaluated the difference in the calcaneal length and height with the uninjured side on the lateral view of both sides. In addition, we estimated the reduction state of the posterior facet by measuring the degree of gap and step-off on the semi-coronal view of postoperative computed tomography and estimated the restoration of calcaneal angle by measuring the difference in Böhler's and Gissane angle with the uninjured side on the lateral view of both sides.

    Results

    The correlation coefficient with 3 components for evaluating the reduction state of posterior tuberosity fragment and gap and step-off of posterior facet was r=0.538, 0.467, r=0.505, 0.456, r=0.518, and 0.493, respectively, and restoration of Böhler's and Gissane angle was r=0.647, 0.579, r=0.684, 0.630, r=0.670, and 0.628, respectively. The relationship of each component shows a significant correlation as all p-values were <0.01.

    Conclusion

    The precise reduction of calcaneal posterior tuberosity fragment developed by the primary fracture line was considered as an important process of anatomical reduction of calcaneal body, including the posterior facet and calcaneal angle restoration.

    Keywords
    Calcaneus; Intra-articular fracture; Posterior tuberosity; Anatomical reduction

    Figures

    Fig. 1
    A 57-year-old male patient, with a Sanders type III intra-articular calcaneal fracture, was treated using open reduction and internal fixation with the extensile lateral approach. (A) Preoperative x-ray and computed tomography (CT) scans. (B) Postoperative x-ray and CT scans showed inaccurate reduction of posterior tuberosity fragment (yellowish arrow line), posterior facet step-off (yellowish circle), and collapsed Böhler's angle (yellowish line).

    Fig. 2
    The degree of lateral displacement of the posterior tuberosity fragment (a) is measured as the gap between the superomedial fragment and posterior tuberosity fragment on the medial aspect of the calcaneal axial view.

    Fig. 3
    The difference in the calcaneal length with the uninjured side (b-b') is measured from the most posterior point of the tuberosity to the calcaneocuboid joint on the lateral view.

    Fig. 4
    The difference in the calcaneal height with the uninjured side (c-c') is measured as a perpendicular distance from the most superior part of the posterior facet to the inferior aspect line between the calcaneocuboid joint and posterior tuberosity on the lateral view.

    Fig. 5
    The relationship between the degree of lateral displacement of the posterior tuberosity fragment and gap/step-off of posterior facet and restoration of Gissane angle/Böhler's angle shows a significant correlation (p<0.01).

    Fig. 6
    The relationship between the difference in calcaneal length with uninjured side and gap/step-off of posterior facet and restoration of Gissane angle/Böhler's angle shows a significant correlation (p<0.01).

    Fig. 7
    The relationship between the difference in the calcaneal height with the uninjured side and gap/step-off of posterior facet and restoration of Gissane angle/Böhler's angle shows a significant correlation (p<0.01).

    Fig. 8
    The primary fracture line (yellowish line) produced two large fragments, SM, and posterolateral fragment (SL and PT). AL: Anterolateral fragment, SL: Superolateral fragment, SM: Superomedial fragment, PT: Posterior tuberosity fragment.

    Fig. 9
    In the semi-coronal computed tomography scan, the tuberosity tilts into the varus and acts as a wedge between SL and SM, preventing a reduction of the posterior facet. SL: Superolateral fragment, SM: Superomedial fragment, PT: Posterior tuberosity fragment.

    Fig. 10
    We apply a distractor between the Schanz screw thread and K-wire inserted into the talar body and can achieve an effective traction of the tuberosity fragment.

    Notes

    Financial support:None.

    Conflict of interest:None.

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    MeSH Terms
    Calcaneus
    Humans
    Intra-Articular Fractures
    Metrics
    Share
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