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At least 199 records · Page 11Linked to original sources
PubMed2006

Importance of greenstick lamina fractures in low lumbar burst fractures.

Lumbar burst fractures (L3-L5) represent a small percentage of all spinal fractures. The treatment of fractures involving the lumbar spine has been controversial. Lamina fractures may be complete or of the greenstick type. Dural tears and nerve root entrapment may accompany these lamina fractures. The aim of this retrospective study was to determine the incidence of dural tear in patients who had lumbar burst fractures with greenstick lamina fractures and the importance of these lamina fractures when choosing the optimum treatment. Twenty-six patients with 28 lumbar burst fractures were treated from 1995 through 2002. The average follow-up was 60 months (range 32-110 months). The male to female ratio was 21:5 and the mean age was 37 years (17-64). Dural tear was detected in seven (25%) out of 28 burst fractures. The functional outcome of the entire study group was assessed using the Smiley-Webster Scale. Good to excellent results were obtained in 24 (92%) of 26 patients. Lumbar burst fractures with greenstick lamina fractures occur mostly in the L2-L4 area. In the surgical treatment, any reduction manoeuvre will close the fracture and crush the entrapped neural elements. Therefore, it may be better to explore the greenstick lamina fracture whether there is any neural entrapment or not, before any reduction manoeuvre is attempted.

Adolescent↗
PubMed1996

A three-dimensional study of loads across the fracture for different fracture sites of the mandible.

The loads across the fracture depend on variables such as position of the fracture and the bite point. Up to now, no study has described systematically the influence of these two variables on these loads. The aim of this study was to describe and compare value and direction of the loads across the fracture for different positions of fractures in the mandible. In a three-dimensional model, bending and torsion moments and shear forces were compared for five mandibular fractures. The fractures were located in, respectively, the angle, posterior body, anterior body, canine and symphysis region. Positive bending moments were defined to give compression at the border, negative bending moments to give compression at the alveolar side of the mandible. The angle and posterior body fracture have high positive bending moments, small torsion moments and high shear forces. The anterior body, canine and symphysis fracture have high negative bending moments and high torsion moments with similar maximum values. The number of bite points with negative bending moments were different for all fractures. These bite points were always located on the fractured side. It is concluded that mandibular fractures can be divided roughly into two groups with similar load patterns across the fracture. One group consists of angle and posterior body fractures, the other group consists of anterior body, canine and symphysis fractures.

Adult↗
PubMed2004

[Fractures of the atlantoaxial complex in the elderly: assessment of radiological spectrum of fractures and factors influencing imaging diagnosis].

OBJECTIVE: To describe patterns of atlantoaxial fractures in a population of consecutive elderly patients, including assessment of type, distribution and associated clinical and radiological findings, and to analyze any influence of the causative trauma mechanism on the individual fracture pattern. MATERIALS AND METHODS: The distribution and type of 123 atlantoaxial fractures in 95 subjects older than 65 years (range: 65 - 102; mean age: 79 years) were retrospectively assessed. For each subject, trauma mechanism and clinical and neurological status were recorded at admission. Initial imaging studies of the cervical spine were reviewed. Preexistent degenerative changes were assessed and the atlantoaxial fractures classified. Data were evaluated for the frequency of different types of fractures of C1 and C2 and for accompanying fractures of cervical vertebrae or the occipital condyles, respectively. RESULTS: The majority of patients with injuries of the atlantoaxial complex had fractures of C2 (90 of 95, 95 %). A large proportion of these patients (67 of 90, 74 %) had odontoid fractures. An isolated fracture of C1 was present in only 5 (5 %) patients. Associated fractures of the occipital condyles or other cervical vertebrae were rare (10 of 95, 11 %). The main trauma mechanism for atlantoaxial injuries was a fall (56 of 95, 59 %). Elderly patients injured in motor vehicle accidents were more likely to have isolated fractures of C2 and Type III fractures of the odontoid (p < 0.02). CONCLUSION: In elderly patients, fractures of the atlantoaxial complex are mainly caused by falls and almost always involve C2. The trauma mechanism influences the fracture pattern.

Accidental Falls↗
PubMed1997

Thoracolumbar burst fracture with horizontal fracture of the posterior column.

STUDY DESIGN: Nine patients with thoracolumbar burst fractures associated with horizontal fractures in the posterior column were studied retrospectively. OBJECTIVES: To clarify the clinical and radiographic findings and evaluate the postoperative results for this type of fracture. SUMMARY OF BACKGROUND DATA: It is not well recognized that burst fractures occasionally are accompanied by horizontal fractures of the posterior column such as those that result from seatbelt-type injuries. This type of burst fracture differs from flexion-distraction injuries combined with burst fracture, which are accompanied by horizontal fractures not only in the posterior but also in the middle column. Radiographic features of these two different types of injuries are very similar to each other, and their differentiation in diagnosis and treatment has not been recognized clearly. METHODS: Patients were reviewed using a combination of clinical records, follow-up examination, and radiographic data (computed tomography [CT], plain radiographs, and tomographs). Anterior spinal fusion was performed in eight patients using the Kaneda device (Mizuhoika Tokyo, Japan), and one was treated by posterior fusion with pedicle screw fixation. The average follow-up period was 4 years. RESULTS: Patients with fractures of this type represented 21% of the 48 patients with thoracolumbar burst fractures. The injury was sustained by falling in all nine patients. All of the burst fractures were Denis' type B. The horizontal fracture was located at the lamina and spinous process in the posterior column of the upper vertebra adjacent to the involved vertebra in all nine patients. The integrity of the ligamentous structures of the middle column, such as the posterior longitudinal ligament, the periosteum, and the outermost anulus, was confirmed at surgery in eight patients, although not in the patient who underwent posterior fusion. One patient required surgery because of progression of kyphotic deformity during conservative treatment. Solid fusion with no complications was noted in all patients. CONCLUSION: This type of burst fracture is not accompanied by ligamentous injuries because of distraction force in the middle column, which is not present in flexion-distraction injuries, but it seems to be more unstable than burst fractures with no horizontal splitting of the posterior column and requires surgical stabilization.

Adult↗
PubMed2001

Dural tears in lumbar burst fractures with greenstick lamina fractures.

STUDY DESIGN: This study investigated the incidence, predictions, and treatment principles of greenstick lamina fractures in lumbar burst fractures. OBJECTIVE: To determine the incidence of dural tears in lumbar burst fracture with greenstick lamina fracture and to find out if any specific clinical and radiographic factors or intraoperative pathologic findings are predictive of dural tears and nerve root entrapment. SUMMARY OF BACKGROUND DATA: A retrospective review was conducted on 45 patients with 47 lumbar burst fractures treated operatively. Ages ranged from 15 to 70 years (average, 33 years). The duration of follow-up ranged from 32 months to 8 years (average, 52 months). METHODS: All clinical charts and radiologic data of these patients were reviewed. Age, sex, etiology, and all the radiologic parameters were analyzed for their association with greenstick lamina fracture and dural tear. Student's t test and multiple logistic regression analysis were used for statistical analysis. RESULTS: Greenstick lamina fracture occurred in 20 (42.5%) of 47 burst fractures. Dural tear was detected in 9 (19%) of 47 burst fractures and was predominantly higher in L3 (6 of 9 burst fractures). According to multiple logistic regression analysis of the data, a 20% increase in the interpedicular distance gives a 79% probability of greenstick lamina fracture. The distance between the edges of greenstick lamina fractures was obviously higher in fractures with dural tear. Neurologic status was completely normal before surgery in three of the patients with dural tear and nerve root entrapment. CONCLUSIONS: It is not possible to detect dural tear and nerve root entrapment in greenstick lamina fracture before surgery. Therefore, if there is any suspicion of such an occurrence, it should be the rule to begin with posterior approach and use the open book technique to expose the dura safely before any reduction maneuver.

Adolescent↗
PubMed2005

Fracture and non-fracture pain in children with osteogenesis imperfecta.

AIM: To describe and compare the characteristics of acute fracture and chronic non-fracture pain in children with osteogenesis imperfecta (OI). METHODS: A questionnaire about fracture-related pain and prospective 7-d diary about non-fracture-related pain was completed by a random sample of 35 children aged 5-18 from a UK national OI service. Main outcome measures included pain intensity, location, frequency, quality, coping strategies and analgesia use. RESULTS: Most children reported moderate to severe pain associated with fractures and less intense non-fracture pain (p<0.001). Pain intensity was significantly higher in the children who used analgesics (p<0.001). The quality of fracture and non-fracture pain differed only for affective words, which were less frequently used to describe non-fracture pain (p=0.002). More activities of daily living (ADLs) were affected by fracture pain than by non-fracture pain (p<0.001). Children reported more frequent use of approach coping strategies with fracture pain and more frequent use of distraction for non-fracture pain (p<0.01). There were no differences in non-fracture pain intensity, duration, quality, effect on ADLs or coping between children who did or did not take bisphosphonates. CONCLUSIONS: Pain is a common occurrence for children with OI and is both acute and chronic in nature, interfering with children's daily living activities. OI pain may not be optimally treated because many children experienced moderate to severe pain despite use of analgesics and/or coping strategies.

Adolescent↗
PubMed2005

Relationship between changes in BMD and nonvertebral fracture incidence associated with risedronate: reduction in risk of nonvertebral fracture is not related to change in BMD.

UNLABELLED: Whether greater treatment-related changes in BMD result in greater decreases in fracture risk is controversial. We analyzed the relationship between BMD change and nonvertebral fracture risk in postmenopausal osteoporotic women from the risedronate fracture program. Change in BMD did not influence the magnitude of risedronate's effect on nonvertebral fractures; the incidence of nonvertebral fractures was equally low in treated patients whose BMD increased or decreased. INTRODUCTION: In untreated patients, low BMD correlates with increased fracture risk. Whether greater increases in BMD induced by anti-osteoporosis drugs are related to greater decreases in vertebral fracture risk is controversial, and little has been written about the relationship between change in BMD and nonvertebral fracture risk. We analyzed the relationship between BMD change and nonvertebral fracture incidence using individual patient data from postmenopausal osteoporotic women receiving antiresorptive treatment with risedronate. MATERIALS AND METHODS: This posthoc analysis combined data from three pivotal risedronate fracture endpoint trials. Women received risedronate 2.5 or 5 mg (n = 2,561) or placebo (n = 1,418) daily for up to 3 years. BMD and nonvertebral fractures confirmed by radiograph (hip, wrist, pelvis, humerus, clavicle, and leg) were assessed periodically over 3 years. RESULTS: The incidence of nonvertebral fractures in risedronate-treated patients was not different between patients whose spine BMD decreased (7.8%) and those whose spine BMD increased (6.4%; hazard ratio to subgroup of patients who lost BMD [HR], 0.79; 95% CI, 0.50, 1.25) or between those whose femoral neck BMD decreased (7.6%) and those whose femoral neck BMD increased (7.5%; HR, 0.93; 95% CI, 0.68, 1.28). The changes in lumbar spine and femoral neck BMD explained only 12% (95% CI, 2%, 21%; p = 0.014) and 7% (95% CI, 2%, 13%; p = 0.005), respectively, of risedronate's nonvertebral fracture efficacy. CONCLUSIONS: For patients treated with risedronate, changes in BMD as measured by DXA do not predict the degree of reduction in nonvertebral fractures.

Aged↗
PubMed2002

Absolute fracture risk varies with bone densitometry technique used. A theoretical and in vivo study of fracture cases.

The lack of consensus of how the results of peripheral bone mineral density (BMD) measurements should be interpreted is proving a barrier to the wider use of these devices. One approach is to interpret peripheral measurements using thresholds (so-called equivalent T-scores) defined to have the same absolute fracture risk as a femoral neck T-score of -2.5. For this concept to be valid, the estimates of fracture risk for a population should be the same irrespective of the measurement technique used. We tested this prediction both theoretically and in vivo using data for 63 postmenopausal women with Colles fracture and 191 control subjects. The theoretical analysis showed that if the normal population has a Gaussian BMD distribution and fracture risk varies exponentially with Z-score as exp(-beta Z) then patients who experience a low-trauma fracture have a fracture risk that is larger by a factor exp(beta(2)) compared with the fracture risk of the whole population. Using data from the in vivo study, fracture risk predictions were compared for seven different types of measurement (lumbar spine; femoral neck; total hip BMD; and speed of sound [SOS] at the radius, tibia, phalanx, and metatarsal). When quantitative estimates of fracture risk were made for individual subjects, the average risk of fracture for the Colles group varied between 1.03 times larger (for tibial SOS) and 2.77 times larger (for total hip BMD) than the average fracture risk for the whole population. As predicted by the theoretical study, fracture risk varied according to the odds ratio determined by logistic regression analysis. Therefore, estimates of fracture risk derived for the same group of patients varied almost threefold according to the type of measurement. It was concluded that equating estimates of absolute fracture risk for different types of scan should not be used as the basis of deriving equivalent T-scores for interpreting peripheral measurements.

Aged↗
PubMed2005

[The relationship between the fracture site and etiology in mandibular fractures].

OBJECTIVES: The aim of this study was to evaluate the relationship between the fracture site and etiology in mandibular fractures. PATIENTS AND METHODS: The study included 37 patients (61 fracture sites) (29 males, 8 females; mean age 26 years; range 1.5 to 77 years) who underwent surgical treatment for mandibular fractures between May 2001 and November 2003. Data on epidemiological characteristics of patients, etiology and fracture sites were retrospectively reviewed. RESULTS: Of the patient group, 51.3% had a single, 48.6% had two or more fractures. Seventy-five percent of the assault victims had more than one fracture site. Motor vehicle accidents accounted for 36% of all the fracture sites. The most common locations of the fractures according to the etiology were as follows: fractures caused by motor vehicle accidents at the parasymphyseal area, by falls at the condyle, and by assaults at the parasymphyseal and angular areas. All the fractures resulting from bicycle accidents occurred at the condyle area. CONCLUSION: It is advisable to be more attentive for condyle fractures when confronted with any etiology of mandibular fractures. Etiology may be suggestive of the fracture site(s).

Adolescent↗
PubMed1994

Risk of hip fracture in women with vertebral fracture.

In a population-based retrospective cohort study, Rochester women aged 35-69 years who were first diagnosed with one or more vertebral fractures in 1950-1979 were followed for the development of a subsequent hip fracture. The 336 women with no history of hip fracture at the time of their vertebral fracture experienced 52 proximal femur fractures in 4788 person-years of follow-up. The standardized morbidity ratio (SMR) of observed to expected hip fractures was 1.8 (95% CI, 1.3-2.4) and was higher for intertrochanteric than cervical femoral fractures (SMR, 2.3 versus 1.3; P = 0.07). Hip fracture risk among women with symptomatic vertebral fractures was slightly less than in those with asymptomatic vertebral fractures (SMR, 1.8 versus 2.3; not significant), and younger women had no higher risk of a subsequent hip fracture than women who were > or = 60 years of age at the time of their vertebral fracture (SMR, 1.4 versus 1.8; not significant). Alternative explanations are possible, but these data are consistent with heterogeneity in the pathogenesis of different osteoporotic fractures.

Adult↗
PubMed2002

Digital X-ray radiogrammetry predicts hip, wrist and vertebral fracture risk in elderly women: a prospective analysis from the study of osteoporotic fractures.

Digital X-ray radiogrammetry (DXR) is a technique that uses automated image analysis of standard hand radiographs to estimate bone mineral density (DXR-BMD). Previous studies have shown that DXR-BMD measurements have high precision, are strongly correlated with forearm BMD and are lower in individuals with prevalent fractures. To determine whether DXR-BMD measurements predict wrist, hip and vertebral fracture risk we conducted a case-cohort study within a prospective study of 9704 community-dwelling elderly women (the Study of Osteoporotic Fractures). We compared DXR-BMD, and BMD of the radius (proximal and distal), calcaneus, femoral neck and posteroanterior lumbar spine in women who subsequently suffered a wrist (n = 192), hip (n = 195), or vertebral fracture (n = 193) with randomly selected controls from the same cohort (n = 392-398). DXR-BMD was estimated from hand radiographs acquired at the baseline visit. The radiographs were digitized and the Pronosco X-posure System was used to compute DXR-BMD from the second through fourth metacarpals. Wrist fractures were confirmed by radiographic reports and hip fractures were confirmed by radiographs. Vertebral fractures were defined using morphometric analysis of lateral spine radiographs acquired at baseline and an average of 3.7 years later. Age-adjusted odds ratio (OR, vertebral fracture) or relative hazard (RH, wrist and hip fracture) for a 1 SD decrease in BMD were computed. All BMD measurements were similar for prediction of wrist (RH = 1.5-2.1) and vertebral fracture (OR = 1.8-2.5). Femoral neck BMD best predicted hip fracture (RH = 3.0), while the relative hazards for all other BMD measurements were similar (RH = 1.5-1.9). These prospective data indicate that DXR-BMD performs as well as other peripheral BMD measurements for prediction of wrist, hip and vertebral fractures. Therefore, DXR-BMD may be useful for prediction of fracture risk in clinical settings where hip BMD is not available.

Absorptiometry, Photon↗
PubMed1996

A locked hip screw-intramedullary nail (cephalomedullary nail) for the treatment of fractures of the proximal part of the femur combined with fractures of the femoral shaft.

Twenty-seven patients with complex femoral fractures (combined shaft and proximal femoral fractures) were treated with a modified Grosse-Kempf slotted locking nail (cephalomedullary nail), wherein two screws were inserted in the hip. Four types of complex, multifocal femoral fractures were represented in the series. Eleven of the femoral shaft fractures were secondary to a previous, internally fixed, not yet united hip fracture (type I). Ten comminuted peritrochanteric fractures occurred in normal bone (type II). Three similar fractures were pathologic because of metastasis. Two patients had an ipsilateral fracture of the femoral shaft and the trochanteric area (type III), and one of the shaft and the femoral neck (type IV). Locking was made static in 24 cases. Additional cerclage wiring was used in three type II fractures. Five complications were as follows: one cutting out of a screw in the femoral head, two fractures of the nail, one deep venous thrombosis, and one wound hematoma. Reoperations were two salvage operations using a new nail and one evacuation of hematoma. One patient with multiple injuries and four elderly patients died within 2 months. Eighteen patients with fractures in normal bone were followed for a median of 20 (6 to 37) months. All fractures united. Two nails were removed. The end result was excellent in ten patients, good in seven, and fair in one (2-cm shortening and 20-degree external rotation). We conclude that a locked intramedullary construct with locking screws in femoral neck and distal femur controls a complex fracture situation well.

Adult↗
PubMed2004

The sternal fracture: radiographic analysis of 200 fractures with special reference to concomitant injuries.

BACKGROUND: The assessment of the sternal fracture and concomitant injuries is discussed. METHODS: Two hundred sternal fractures were analyzed with respect to accident circumstances, fracture morphology and topography, and associated injuries. RESULTS: Traffic accidents were frequent; 89.2% of them were motor vehicle crashes of restrained passengers, 76.5% of fractures were localized in the corpus sterni, and 8.5% of the injuries resulted in fractures or complete disruptions of the synchondrosis manubriosternalis. Nondisplaced or slightly displaced fractures (75.5%) occurred more frequently compared with moderately and severely displaced fractures (24.5%). In 29.5% of the patients, concomitant thoracic injuries were diagnosed. Spinal fractures were evaluated in 13%. In displaced fractures of the corpus, thoracic and cardiac injuries were observed frequently. In fractures or disruptions of the synchondrosis manubriosternalis, concurrence of spinal fractures clearly increased. CONCLUSION: The observation of fracture morphology and topography, with reference to displacement, gives important information about the existence of serious concomitant injuries and can determine further diagnostic and therapeutic options in sternal fractures.

Accidents, Traffic↗
PubMed2003

Nulliparity and fracture risk in older women: the study of osteoporotic fractures.

Whether nulliparity increases fracture risk is unclear from prior studies, which are limited by small samples or lack of measured bone mineral density. No study has evaluated whether the effect of parity differs by skeletal site. We prospectively analyzed the relationship of parity to the risk of incident nontraumatic hip, spine, and wrist fractures in 9704 women aged 65 years or older participating in the Study of Osteoporotic Fractures to determine if parity reduces postmenopausal fracture risk, and if so, if this risk reduction is (1) greater at weight-bearing skeletal sites and (2) independent of bone mineral density. Parity was ascertained by self-report. Incident hip and wrist fractures were determined by physician adjudication of radiology reports (mean follow-up, 9.8 years) and spine fractures by morphometric criteria on serial radiographs. The relationship of parity to hip and wrist fracture was assessed by proportional hazards models. Spine fracture risk was evaluated by logistic regression. Compared with parous women, nulliparous women (n = 1835, 19%) had an increased risk of hip and spine, but not wrist, fractures. In multivariate models, parity remained a significant predictor only for hip fracture. Nulliparous women had a 44% increased risk of hip fractures independent of hip bone mineral density (hazards ratio, 1.44; 95% CI, 1.17-1.78). Among parous women, each additional birth reduced hip fracture risk by 9% (p = 0.03). Additionally, there were no differences in mean total hip, spine, or radial bone mineral density values between nulliparous and parous women after multivariate adjustment. In conclusion, childbearing reduces hip fracture risk by means that may be independent of hip bone mineral density.

Aged↗
PubMedDate not supplied

Recommendations for optimal care of the fragility fracture patient to reduce the risk of future fracture.

Fragility fractures resulting from low trauma events such as a fall from standing height affect up to one half of women and one third of men after age 50 years. These fractures are frequently associated with osteoporosis. History of a fragility fracture is among the strongest risk factors for future fracture. Therefore, optimal care of the patient with a fragility fracture includes not only treatment of the presenting fracture itself but also evaluation and treatment of the underlying cause or causes to prevent future fractures. However, despite the availability of therapeutic agents that reduce fracture risk among osteoporotic patients who have had a fracture, most patients with fragility fractures are not evaluated for osteoporosis or treated adequately to reduce the risk of future fracture. Orthopaedic surgeons are the first and often the only physicians seen by fracture patients. Thus, they have the unique opportunity to serve as primary advocates to ensure that appropriate action is taken to reduce the risk of future fracture.

Age Factors↗
PubMed1997

Is the metatarsal fracture in postmenopausal women an osteoporotic fracture? A cross-sectional study on 113 cases.

To evaluate whether metatarsal fracture in postmenopausal women can be related to osteoporosis, a sample of 113 postmenopausal women with metatarsal fracture due to minor trauma were recruited. Demographic and clinical data were compared with a control group of 339 healthy age-matched women and with a sample of 224 women with wrist fracture. In all women, bone mineral density (BMD) was measured at the lumbar spine by dual-energy X-ray absorptiometry. The average age of the metatarsal fracture group was slightly lower than that of the wrist fracture group (56.9 vs 58.4 years). Women with metatarsal and wrist fracture had a significantly higher age at menarche, lower age at menopause and lower body mass index when compared with controls. In both fracture groups BMD was significantly lower compared with controls. In stepwise logistic regression models, factors associated with metatarsal fracture risk were age at menopause (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.81-0.92) and BMD (OR per -1 SD 2.44; CI 1.92-3.11). Factors associated with wrist fracture risk included age at menopause (OR 0.89; CI 0.84-0.93) and BMD (OR per -1 SD 2.65; CI 2.17-3.24). The similarities existing in risk factors and their estimates between a well-recognized osteoporotic fracture such as wrist fracture and metatarsal fracture, support the hypothesis that the latter can be included among osteoporotic fractures.

Adult↗
PubMed1999

Early complications of surgically managed ankle fractures related to the AO classification.A review of 118 ankle fractures treated with open reduction and internal fixation.

The charts of 118 consecutive ankle fractures were reviewed. The patients' age, sex, energy of trauma, hospital stay, need for traction therapy, syndesmosis fixation and soft-tissue problems were related to the various types of fractures according to the AO classification. An interobserver check study revealed an agreement of 0.61 (kappa), which is considered good. The age of the patients with A-fractures was 33 years (SD +/- 13), B-fractures 56 years (SD +/- 18), and C-fractures 48 years (SD +/- 16). The age differences within these groups were highly significant (P < 0.005). The highest average ages were found in the patients with B2 and B3 type fractures, 57 and 61 years, respectively. Women were significantly older than men (P < 0.0001), and 61% of the patients were women. Perioperative problems, such as wound margin necrosis and infections, were significantly related to fracture types B2 and B3. Preoperative traction therapy was necessary in the least stable fractures, of which all but one C1 fracture were B2/3 type fractures. The energy of trauma was not related to perioperative problems. The period of hospitalisation was significantly longer in the patients with B2/B3 type fractures (P < 0.001). Judging by the significantly higher incidence of perioperative complications, longer hospital stay, and predominance of instability and skin damage in the AO B2 and B3 type fractures, these fractures may benefit from more attentive and urgent care.

Adult↗
PubMedDate not supplied

The effect of primary fracture line location on the pattern and severity of intraarticular calcaneal fractures: a retrospective radiographic study.

This retrospective radiographic study sought to evaluate how primary fracture line location relates to the pattern and severity of intraarticular calcaneal fractures. Preoperative lateral radiographs and semicoronal computed tomography scans of 100 displaced intraarticular calcaneal fractures (89 patients) were evaluated for Bohler's angle, Sanders classification, and calcaneocuboid, anterior, or middle subtalar articular involvement. Primary fracture line location was measured on semicoronal computed tomography views as a ratio of the width of the posterior facet. There were 60 Sanders type II (29 IIA, 29 IIB, 2 IIC), 35 type III (10 IIIAB, 9 IIIAC, 16 IIIBC) and 5 type IV fractures. The mean Bohler's angle was 10.1+/-15.6 degrees. The mean primary fracture line location was calculated to be found at 45.7+/-18.2% of the width of the posterior facet, as measured from lateral to medial. Statistical analysis found a significant association between primary fracture line location and Sanders class (r=.636; P<.001) and Bohler's angle (r=-.287; P=.005); as the fracture line moved medially, comminution increased and Bohler's angle decreased. Forty-eight percent of the fractures involved the calcaneocuboid joint; 39% involved the anterior (n=28) or middle (n=11) subtalar facets, or both. A medial primary fracture line correlated to greater involvement of the calcaneocuboid joint (r=.247; P=.015) and the anterior (r=.241; P<.001) and middle (r=.344; P=.003) facets. These results suggest that intraarticular calcaneal fractures exhibiting a medial primary fracture line are associated with a more severe fracture pattern and an increased incidence of anterior articular extension.

Calcaneus↗