Ghorbanhoseini Mohammad, Ghaheri Azadeh, Walley Kempland C, Kwon John Y
Harvard Medical School, BIDMC, Carl J. Shapiro Department of Orthopaedics, Boston, MA, USA
Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
Foot Ankle Int. 2016 Oct;37(10):1076-1083. doi: 10.1177/1071100716651965. Epub 2016 Jun 8.
Intra-articular calcaneus fractures result in heel shortening, widening, varus malalignment, and loss of height. Little has been written regarding superior displacement of the calcaneal tuber, which warrants consideration as previous literature has demonstrated issues arising from a shortened triceps surae. We sought to determine the amount of tuber elevation seen in calcaneus fractures as compared to normal calcanei and propose 2 new measurements that aid in quantifying displacement and may aid in the surgical management of calcaneus fractures.
Lateral radiographs of 220 normal calcanei were examined. Two novel measurements, the talo-tuber angle and talo-tuber distance, were used to establish normative data for calcaneal tuber positioning. Lateral radiographs of 50 calcaneus fractures treated operatively were examined and the same measurements were obtained before and after surgery to determine the amount of superior tuber elevation.
Normative data demonstrated a mean of 38.6 degrees (±SD = 4.3, range: 26.2-58.4) when using the talo-tuber angle and 54.5 mm (±SD = 7.3, range: 36.2-72.6) when using the talo-tuber distance in normal calcanei. Patients sustaining calcaneus fractures demonstrated a mean of 29.5 degrees (±SD = 5.9, range: 20-46.4) for the talo-tuber angle and 39.0 mm (±SD = 9.4, range: 24.0-62.9) for the talo-tuber distance. These values changed to a mean of 37 degrees (±SD = 5.2, range: 26.4-50) for the talo-tuber angle and 51.8 mm (±SD = 8.6, range: 33.2-75.7) for the talo-tuber distance after surgery. There was a statistically significant difference (P value < .01) for both talo-tuber angle and distance between normal and fractured calcanei. Inter- and intra-observer agreement was excellent.
Superior displacement of the calcaneal tuber is a deformity seen in intra-articular calcaneus fractures that has been poorly described that warrants increased awareness and correction at the time of surgery. We propose 2 novel measurements with associated normative data that may aid surgeons in quantifying this deformity and assessing anatomic reduction.
Level III, comparative study.
跟骨关节内骨折会导致足跟缩短、变宽、内翻畸形以及高度丢失。关于跟骨结节上移的相关论述较少，鉴于既往文献已表明小腿三头肌缩短会引发问题，故有必要对此予以关注。我们试图确定跟骨骨折时跟骨结节抬高的程度，并与正常跟骨进行比较，同时提出两种新的测量方法，这有助于量化移位情况，并可能有助于跟骨骨折的手术治疗。
对220例正常跟骨的侧位X线片进行检查。采用两种新的测量方法，即距骨 - 结节角和距骨 - 结节距离，以建立跟骨结节定位的正常数据。对50例接受手术治疗的跟骨骨折患者的侧位X线片进行检查，并在手术前后进行相同的测量，以确定跟骨结节上移的程度。
正常跟骨使用距骨 - 结节角测量时，其平均值为38.6度（标准差±SD = 4.3，范围：26.2 - 58.4）；使用距骨 - 结节距离测量时，平均值为54.5毫米（标准差±SD = 7.3，范围：36.2 - 72.6）。跟骨骨折患者的距骨 - 结节角平均值为29.5度（标准差±SD = 5.9，范围：20 - 46.4），距骨 - 结节距离平均值为39.0毫米（标准差±SD = 9.4，范围：24.0 - 62.9）。手术后，距骨 - 结节角平均值变为37度（标准差±SD = 5.2，范围：26.4 - 50），距骨 - 结节距离平均值变为51.8毫米（标准差±SD = 8.6，范围：33.2 - 75.7）。正常跟骨与骨折跟骨的距骨 - 结节角和距离均存在统计学显著差异（P值 < 0.01）。观察者间和观察者内的一致性良好。
跟骨结节上移是跟骨关节内骨折中出现的一种畸形，此前描述较少，在手术时应提高对此的认识并进行矫正。我们提出了两种新的测量方法及相关正常数据，这可能有助于外科医生量化这种畸形并评估解剖复位情况。
III级，比较研究。
