Three-Dimensional CT Mapping of Intra-articular Calcaneal Fractures

Background: Intra-articular calcaneal fracture is a challenge for surgeons, which must be understood to provide optimal treatment. The aim of this study was to define the distribution of the primary fracture line and the secondary fracture line of intra-articular calcaneal fractures. Methods: All X-rays and CT scans of intra-articular calcaneal fractures were collected from January 2014 to July 2020. According to the classification of Essex-Lopresti, these fractures were divided into tongue-fracture group and compression-fracture group. Construct 3D models of intra-articular calcaneal fractures in all patients, and record the location of all fracture lines, which were marked and integrated on the 3D model of intact calcaneus after virtual reduction. Heat mapping were created based on the occurrence frequency of fracture lines. Results: A total of 171 patients with intra-articular calcaneal fractures were included in this study, 4 of whom were bilateral. There were 87 cases in the tongue-fracture group, 37 cases (42.5%) involved 4 anterior articular surface, 16 cases (18.4%) involved middle articular surface, and 52 cases (59.8%) involved calcanecuboid articular surface. There were 88 cases in the compression-fracture group, including 43 cases (48.9%) involving anterior articular surface, 21 cases (23.9%) involving middle articular surface, and 63 cases (71.6%) involving calcanecuboid articular surface. Conclusion: The distribution of the primary fracture line and the secondary fracture line of intra-articular calcaneal fractures has a certain rule and correlation. Whether in tongue-fracture group or compression-fracture group, the fracture line is most often involves the calcanecuboid articular surface, followed by anterior articular surface, at least involves middlearticular surface. This study provides a theoretical basis for further exploration of calcaneal injury mechanism, construction of biomechanical model, and choice of surgical approach.

Inter-rater reliability of Böhler and Gissane angles in different calcaneal fracture according to the Essex-Lopresti and Sanders classifications

Objective: To evaluate the inter-rater reliability and intra-class correlation coefficients (ICC) of Böhler’s angle and the critical angle of Gissane in calcaneal fractures, stratified by severity and by the Essex-Lopresti and Sanders classifications. Methods: Retrospective study of radiographs obtained from 97 patients: 67 with calcaneal fractures and 30 with normal lateral radiographs (used as a control group). Böhler’s angle and the angle of Gissane were measured by six raters: two orthopedic surgery residents, two musculoskeletal radiologists, a foot and ankle surgery fellow, and a senior consultant in foot surgery. Statistical analysis of inter-rater reliability was performed for the two angles, in the sample overall and stratified by the different radiographic and CT subtypes of calcaneal fractures. Results: For the angle of Gissane, the ICC was at best 0.400 (95% CI: 0.250 to 0.581) for normal radiographs, with poor agreement across all classifications and severity stratifications. For Böhler’s angle, the ICC values indicated weak to moderate agreement, with the best reproducibility obtained for the overall sample (0.740; 95% CI: 0.673 to 0.801). In Sanders type 1 fractures, the ICC was 0.704 (95% CI: 0.397 to 0.940), and in Sanders type 2 fractures, 0.762 (95% CI: 0.634 to 0.870). Conclusion: Böhler’s angle is more reproducible than the critical angle of Gissane, with greater inter-rater reliability among fractures deemed less severe on the Sanders classification, although the overall ICC ranged from weak to moderate at best. Level of Evidence III; Case Control Study; Diagnostic Studies.

Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture: a randomized clinical trial

Objectives The aim of this study was to evaluate the postoperative analgesia effect of ultrasound-guided single popliteal sciatic nerve block for calcaneal fracture. Methods A total of 120 patients scheduled for unilateral open reduction and internal fixation of calcaneal fracture were enrolled in this prospective randomized study. Patients in group B received ultrasound-guided single popliteal sciatic nerve block after operation, but Patients in group A did not. All patients received patient-controlled intravenous analgesia (PCIA) after operation. The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use and the total number of times the patient pressed the analgesia pump were recorded. The time of rescue analgesia and the adverse reactions were recorded. Pain magnitude of the patients immediately after discharge from operating room (T1), and at 4th (T2), 8th (T3), 12th (T4), 16th (T5), 24th (T6) and 48th (T7) h after the operation were assessed with visual analog scale (VAS). In addition, patient, surgeon and nurse satisfaction were recorded. Results The VAS scores at T2 ~ T5, the time of rescue analgesia and the adverse reactions, the total number of times the patient pressed the analgesia pump were significantly declined in group B (p < 0.001). The time to initiation of PCIA, the time of first pressing the analgesia pump, duration of analgesia pump use were prolonged and patient surgeon and nurse satisfaction were improved in group B (p < 0.05). Conclusion Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture. Trial registration ChiCTR, ChiCTR2100042340. Registered 19 January 2021, URL of trial registry record: http://www.chictr.org.cn/showproj.aspx?proj=66526.