Analysis Of Correlation Between Reduction Quality Of Posterior Subtalar Articular Surface And Curative Effect Of Calcaneal Fracture

Objective:1. In this study, based on the MSCT scanning we compared and analyzed thecorrelation between curative effect of calcaneal fracture and the maximumdisplacement of posterior subtalar articular surface in horizontal and vertical direction,the distribution of fracture line, Bohler and Gissane angle of the calcaneus.2.Explored to the reduction standard of posterior subtalar articular surface in intra-articular calcaneus fracture and provide evidence for the treatment.Methods:1. Patients of the study：from February2012to February2014, there were30patients(37feet) with calcaneal fracture treated in the Third Affiliated Hospital ofJinan University (Zhuhai People’s Hospital) trauma department of orthopedics andfollowed up over9months, the data of patients was collected include the original dataof clinical information, X-ray, CT(computed tomography) scan and the score ofpatients’ ankle function.2. Roughness measurement of the posterior subtalar articular surface: Based on thethin slice CT scan measure the the maximum distance of displacement in horizontaland vertical direction. According to the maximum displacement we divided theroughness into3grades, maximum displacement≤2mm is good,2mm <maximumdisplacement distance≤4mm is general, maximum displacement>4mm is bed. 3. Determination of the fracture line region: in the coronal plane, the posteriorsubtalar joint surface is divided into medial and lateral two parts and determined themaximum displacement region.4. Measurement of Bohler and Gissane angle: based on the calcaneus lateral X-rayplain film, Bohler angle is made with the lines which from the vertex of posteriorsubtalar articular surface respectively to the edge of calcaneocuboid articular surfaceand the margin of calcaneal tuberosity. Gissane angle is made with the lines whichfrom calcaneal sulcus respectively to the vertex of posterior subtalar articular surfaceand the edge of calcaneocuboid articular surface.5. Methods of ankle and hindfoot function score: according to AOFAS (AmericanOrthopeadic Foot and Ankle Society), three senior orthopedic surgeons gave a markto the ankle and hindfoot after fracture healing and normal walking also took theaverage.6. Data collection and statistical analysis: The storage of all the data was by input tothe computer Excel file. We used SPSS13.0statistical software to analyze thecorrelation between each factor and AOFAS score with Logistic regression analysisand compare the excellent and good rate withχ2test, P<0.05was statisticallysignificant.Results:1. Through single factor and multi factors non conditional Logistic regression analysis,we find that the maximum displacement of posterior subtalar articular surface inhorizontal and vertical direction impact on patient AOFAS score (P<0.05) and verticaldisplacement distance on effect of functional ankle and hindfoot recovery is strongerthan the horizontal displacement, standardized regression coefficients were-0.517and-0.461. 2. No matter horizontal displace or vertical displace of the posterior subtalar articularsurface the excellent and good rate of≤2mm group were significantly higher than the>2mm group(P=0.031,0.017).3. There is no correlation between curative effect of calcaneal fracture and themaximum displacement region, Bohler, Gissane angle. Also the difference ofexcellent and good rate among2regions is not statistically significant (P>0.05).Conclusions:1. The recovery of ankle and hindfoot is closely related to the roughness of posteriorsubtalar articular surface and vertical displace on effect of ankle and hindfootrecovery is stronger than the horizontal displace.2. In the treatment of intra-articular calcaneus fracture we should try to reduce theposterior subtalar articular surface under2mm.3. In the measurement of calcaneus fracture reduction quality, MSCT is more accuratethan X-ray plain filn.