Rothberg David L, Yoo Brad J
University of Utah, Salt Lake City, UT, USA
Oregon Health Sciences University, Portland, OR, USA.
Foot Ankle Int. 2014 Oct;35(10):970-4. doi: 10.1177/1071100714540889. Epub 2014 Jun 24.
Direct visualization of the posterior facet in displaced intra-articular calcaneus fractures (DIACF) frequently shows partial or full thickness cartilage delamination. This is felt to be secondary to the depression of an osteoarticular segment of the posterior facet within the calcaneal body and the subsequent contact with fracture edges as it impacts caudally. The purpose of this study was to determine the frequency of cartilage injury and if it correlates with fracture classification.
A single surgeon prospective, observational series of 28 patients with 28 DIACFs was reviewed for patient demographic and injury data, radiographic fracture characterization, and intraoperative observation of articular injury size, depth, and location over the time period of February 2010 to December 2012. Observations were correlated with the OTA and Sanders classification systems.
Age, sex, mechanism of injury, and depth and location of cartilage injury were not significantly different between the 13 OTA/Sanders type 2 and 15 type 3 DIACFs evaluated in this study. Posterior facet articular cartilage delamination was found in 77% of type 2 and 100% of type 3 fractures (P = .09). Location of cartilage injury was common (56%) along the distal, lateral aspect of the posterior facet (P < .05). The percentage area of cartilage injury was significantly larger in type 3 fractures (3.1%) then type 2 (1.3%) (P < .02).
DIACFs had a consistent location of posterior facet articular cartilage delamination along the distal lateral aspect of the osteoarticular fragment. This lesion was larger in OTA/Sanders classification type 3 fractures compared to type 2 fractures.
Level IV, prospective, observational series.
在移位的关节内跟骨骨折（DIACF）中，后关节面的直接可视化检查经常显示部分或全层软骨分层。这被认为是跟骨体内后关节面的骨关节段凹陷以及随后其向尾侧撞击时与骨折边缘接触的继发结果。本研究的目的是确定软骨损伤的频率及其是否与骨折分类相关。
回顾了由一位外科医生进行的、对28例患者的28处DIACF的前瞻性观察系列，以获取患者人口统计学和损伤数据、影像学骨折特征，以及在2010年2月至2012年12月期间对关节损伤大小、深度和位置的术中观察结果。观察结果与OTA和Sanders分类系统相关。
在本研究评估的13例OTA/Sanders 2型和15例3型DIACF之间，年龄、性别、损伤机制以及软骨损伤的深度和位置无显著差异。在2型骨折中，77%发现后关节面软骨分层，在3型骨折中为100%（P = 0.09）。软骨损伤位置常见于后关节面远侧外侧（56%）（P < 0.05）。3型骨折的软骨损伤面积百分比（3.1%）显著大于2型骨折（1.3%）（P < 0.02）。
DIACF的后关节面软骨分层在骨关节碎片的远侧外侧有一致的位置。与2型骨折相比，该病变在OTA/Sanders分类3型骨折中更大。
IV级，前瞻性观察系列。
