Fracture mapping of complex intra-articular calcaneal fractures

Ming Ni; Miko Lin Lv; Wanju Sun; Yingqi Zhang; Jiong Mei; Duo Wai-Chi Wong; Haowei Zhang; Yongwei Jia; Ming Zhang

doi:10.21037/atm-20-7824

Fracture mapping of complex intra-articular calcaneal fractures

Ann Transl Med. 2021 Feb;9(4):333. doi: 10.21037/atm-20-7824.

Authors

Ming Ni¹, Miko Lin Lv², Wanju Sun¹, Yingqi Zhang³, Jiong Mei⁴, Duo Wai-Chi Wong^{5

6}, Haowei Zhang², Yongwei Jia⁷, Ming Zhang^{5

6}

Affiliations

¹ Department of Orthopaedics, Pudong New Area People's Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China.
² School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China.
³ Department of Orthopaedics, Tongji Hospital of Tongji University, Shanghai, China.
⁴ Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China.
⁵ Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong, China.
⁶ The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.
⁷ Department of Spine Surgery, Guanghua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.

Abstract

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.

Keywords: 3D computed tomography; Calcaneal fracture; classification; fracture pattern; mapping.