Department of Orthopedics, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
Department of Rehabilitation, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, 519000, Guangdong, China.
Sci Rep. 2023 May 31;13(1):8827. doi: 10.1038/s41598-023-34711-w.
To determine the pattern of intra-articular calcaneal fractures (ICFs) by a three-dimensional (3D) mapping and determine whether there were consistent fracture patterns and comminution zones. In this study, 67 patients with ICFS by CT scan were included. The calcaneal fractures fragments in CT were multiplanar reconstructed and virtual reduced. 3D heat mapping was subsequently created by graphically superimposing all fracture lines onto a standard calcaneal template. The cohort included 26 (38.8%) left calcaneal fractures, 27 (40.30%) right calcaneal fractures, and 14 (20.9%) cases with bilateral fractures. Comminuted fractures accounted for 92.5%. Sagittal 3D mapping shows that the fracture line is mainly concentrated at the critical angle of Gissane and extending rear to the posterior of the tuberosity of the lateral wall and the anterior of the medial process of the calcaneus tuberosity but with more significant variation in the medial wall. The average angle of fracture lines concerning the long calcaneal axis (LCA) was 29.1° and 19.2° in the lateral and medial walls. Axial 3D mapping shows that fracture lines were primarily concentrated in the anterior area to the posterior joint facet and extending along the rear joint facet and calcaneus sulcus to the posteriorly of the tuberosity. The mean angle of fracture lines concerning the LAC was 11° in the axial wall. Our data provided elucidated that ICFs have consistent characteristic fracture patterns and comminution zones. This study provides visual guidelines for understanding fracture morphology, which may assist with fracture classification, preoperative planning, development of fixation concepts.
为了通过三维（3D）映射确定关节内跟骨骨折（ICF）的模式，并确定是否存在一致的骨折模式和粉碎区域。在这项研究中，共纳入了 67 例 CT 扫描证实的 ICF 患者。对 CT 中的跟骨骨折碎片进行多平面重建和虚拟复位，然后通过将所有骨折线图形叠加到标准跟骨模板上来创建 3D 热映射。该队列包括 26 例（38.8%）左侧跟骨骨折、27 例（40.30%）右侧跟骨骨折和 14 例（20.9%）双侧骨折。粉碎性骨折占 92.5%。矢状面 3D 映射显示，骨折线主要集中在 Gissane 临界角，并向后延伸至外侧壁结节的后部和跟骨结节的内侧突的前部，但内侧壁的变化更为明显。关于长跟骨轴（LCA）的骨折线的平均角度在外侧壁和内侧壁分别为 29.1°和 19.2°。轴向 3D 映射显示，骨折线主要集中在前关节面后部，沿后关节面和跟骨沟向后延伸至结节后部。轴向壁上骨折线关于 LAC 的平均角度为 11°。我们的数据表明，ICF 具有一致的特征性骨折模式和粉碎区域。本研究为理解骨折形态提供了直观的指导，这可能有助于骨折分类、术前规划、固定概念的发展。
