Ogut Tahir, Ayhan Egemen, Kantarci Fatih, Unlu Mehmet C, Salih Muhammet
Department of Orthopaedics and Traumatology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey.
J Foot Ankle Surg. 2011 Sep-Oct;50(5):517-21. doi: 10.1053/j.jfas.2011.04.018. Epub 2011 May 31.
In Sanders' classification of calcaneus fractures, the medial fracture line (subtype C) is close to the tarsal canal, which contains an artery for the talus and calcaneus. We hypothesized that because of this brittle vascular localization, patients with C line fracture patterns might describe radiologic subtalar arthritis more often and have more complaints. The purpose of the present study was to compare the results of C line fracture patterns with other types of calcaneus fractures. A total of 25 surgically treated feet were involved. Regarding Sanders' classification, group 1 included fractures involving the C line (11 feet), and group 2 included fractures not involving the C line (14 feet). Patient age at admission, trauma date, and interval until surgery were obtained from the patients' medical records. The Bohler angles were determined from the radiographs. At the last follow-up visit, the radiologist graded subtalar arthritis using computed tomography. For clinical follow-up, the American Orthopaedic Foot and Ankle Society and Maryland scores were assessed. No significant differences were found in mean age, follow-up period, delay to surgery, or postoperative Bohler angle between the 2 groups. The mean preoperative Bohler angle was significantly low for group 1. Although not significantly different, the mean American Orthopaedic Foot and Ankle Society and Maryland scores were lower for group 1 (81.9 and 84.3) than group 2 (87.8 and 92.0), and the median subtalar arthritis grade was greater for group 1 (score 2) than for group 2 (score 1.5). The worse results with C line fracture patterns despite satisfactory reduction might result from sinus tarsi artery damage. Angiographic investigations could clarify this theory in the future. Consequently, surgeons must inform and should hesitate to operate on patients with these highly comminuted C line calcaneus fractures.
在桑德斯（Sanders）跟骨骨折分类中，内侧骨折线（C型）靠近跗管，跗管内有供应距骨和跟骨的动脉。我们推测，由于这种血管定位脆弱，C线骨折模式的患者可能更常出现影像学距下关节炎且有更多不适主诉。本研究的目的是比较C线骨折模式与其他类型跟骨骨折的结果。共纳入25例接受手术治疗的足部病例。按照桑德斯分类，第1组包括涉及C线的骨折（11足），第2组包括不涉及C线的骨折（14足）。从患者病历中获取入院时的年龄、受伤日期及手术间隔时间。通过X线片测定博勒（Bohler）角。在最后一次随访时，放射科医生利用计算机断层扫描对距下关节炎进行分级。对于临床随访，评估美国矫形足踝协会（American Orthopaedic Foot and Ankle Society）评分及马里兰（Maryland）评分。两组在平均年龄、随访时间、手术延迟或术后博勒角方面均未发现显著差异。第1组术前平均博勒角显著较低。虽然差异无统计学意义，但第1组的美国矫形足踝协会评分及马里兰评分均值（分别为81.9和84.3）低于第2组（分别为87.8和92.0），且第1组距下关节炎分级中位数（评分为2）高于第2组（评分为1.5）。尽管复位满意，但C线骨折模式结果较差可能是由于跗窦动脉损伤所致。血管造影检查未来可能会阐明这一理论。因此，外科医生必须告知并应谨慎对这些高度粉碎性C线跟骨骨折患者进行手术。
