The Study Of Correlation Between Sanders Classification Of Calcaneal Fractures And Grading Of Calcaneocuboid Joint Injury

Objective:The calcaneocuboid joint injury in calcaneal fractures is aneasily overlooked problem, its diagnosis is mainly depended on the calcanealaxial CT results. scholars have classified the degree of calcaneocuboid jointinjury based on the results of CT examination,and discussed the prognosis ofthe injury,it was agreed that the the degree of calcaneocuboid joint injuryincrease with the severity of calcaneal fracture increased,but we did not findthat scholars made the quantitative statistical research of Correlation betweenSanders classification of calcaneal fractures and Grading of CalcaneocuboidJoint injury.In this study, by reviewing the CT image data of calcanealfractures with calcaneocuboid joint injury,we study the imaging Correlationbetween Sanders classification of calcaneal fractures and Grading ofCalcaneocuboid Joint injury.we hope our results can help clinicians andimprove the understanding of the injury.Methods:163cases with188calcaneal fractures accompaniedcalcaneocuboid Joint injury were reviewed in our hospital From July2007toOctober2011,which included171ankles of148males and17ankles of15females with an average age of38.04(range,16-72years).90left ankles and98right ankles.164falls injuries,15traffic injuries,6stairs injuries,3crushinjuries.32cases combined with other damage, including15cases of lumbarfractures,8patients suffering from open injury,3cases of contralateralscaphoid fracture,2cases of ipsilateral ankle fracture,2cases of ipsilateraltalus fracture,2cases with ipsilateral cuboid fracture. According to the resultsof CT scan taken preoperatively and Sanders classification of calcanealfractures, the188calcaneal fractures were divided into4groups:Sanders TypeI:26ankles,13.8%(26/188)；Sanders Type II:43ankles,22.9%(43/188)；Sanders Type III:91ankles,48.4%(91/188)；Sanders Type IV:28ankles, 14.9%(28/188).Then we recorded the Bernd Type through the calcanealaxial CT results one by one.Bernd used axial CT scans to analyze theinvolvement of the CCJ, which was classified as undisplaced or minimallydisplaced (<2mm of articular step or gap), moderately displaced (>2mm ofarticular step or gap), displaced (several fracture lines), and complex (fracturedislocation, additional fracture of the cuboid).At last,we analysis the results bySPSS16.0statistical software.Results:①The incidence of cacaneocuboidal involvement in4groups:Type I:26.9%(7/26)；Sanders Type II:60.5%(26/43)；Sanders TypeIII:89.0%(81/91)；Sanders Type IV:100%(28/28)(x2=56.54,P<0.01).②Theincidence of cacaneocuboidal involvement in188is75.5%(142/188),and theincidence of cacaneocuboidal involvement of every Bernd type：Bernd TypeI:18.6%(35/188)； Bernd Type II:19.1%(36/188)； Bernd TypeIII:26.1%(49/188)； Bernd Type IV:11.7%(22/188)。③the Proportion ofcacaneocuboidal involvement in Sanders Type I calcaneal fractures: BerndType I:15.4%(4/26)；Bernd Type II:7.7%(2/26)；Bernd Type III:3.8%(1/26)；Bernd Type IV:No.Sanders Type II：Bernd Type I:32.6%(14/43)；Bernd TypeII:16.3%(7/43)；Bernd Type III:11.6%(5/43)；Bernd Type IV:No.Sanders TypeIII：Bernd Type I:16.9%(15/91)；Bernd Type II:17.4%(25/91)；Bernd TypeIII:23.7%(34/91)；Bernd Type IV:10.6%(7/91).Sanders Type IV:Bernd TypeI:7.1%(2/28)；Bernd Type II:7.1%(2/28)；Bernd Type III:32.1%(9/28)；BerndType IV:53.6%(15/28).(Kruskal-Wallis tests,x2=81.002, P<0.01,Mann-Whitney U Tests,P<0.01).④Spearman Correlation is0.657(P<0.01),Pearsonx2=121.40(P<0.01), Linear-by-LinearAssociation=79.46(P<0.01),Pearson's R=0.652(P<0.01).Conclusion:①Intra-articular calcaneal fractures are often accompaniedby the calcaneocuboid joint injury, and the incidence of calcaneocuboid jointinjury which are differences among the various Sanders types is75.5%.②Theproportion and severity of cacaneocuboidal joint injury are differences amongSanders types.③The Type of Calcaneocuboid Joint injury is related with theSanders classification of calcaneal fractures,the degree of calcaneocuboid joint injury increase with the severity of calcaneal fracture increased.④The totalincidence of Bernd Type III and Bernd Type IV is89.0%in Sanders TypeIII,and100%in Sanders Type IV,so Clinicians should seriously treat theSanders type III calcaneal fracture and Sanders type III.⑤Sandersclassification is not suitable for the calcaneal fractures with calcaneocuboidjoint involvement,it is more suitable for the assessment of the subtalar joint,wecan considere improving the Sanders classification, and make the Sandersclassification more instructive for clinical treatment.