School of Physical Education, Southwest Medical University, Luzhou, China.
Department of Rehabilitation, Yibin Integrated Traditional Chinese and Western Medicine Hospital, Yibin, China.
Orthop Surg. 2024 May;16(5):1196-1206. doi: 10.1111/os.14033. Epub 2024 Mar 14.
The talus is an important component in the ankle, and its treatment after injury is crucial. However, complications and adverse events due to incomplete traditional classifications may still occur, and these classifications fail to analyze the patterns and distribution of fractures from a three-dimensional perspective. Therefore, in this study, we aimed to analyze the location and distribution of fracture lines in different types of talus fractures using three-dimensional (3D) and heat mapping techniques. Additionally, we aimed to determine the surface area of the talus that can be utilized for different approaches of internal fixation, aiding in the planning of surgical procedures.
We retrospectively analyzed data from CT scans from 126 patients diagnosed with talus fractures at our two hospitals. We extracted the CT data of a healthy adult and created a standard talus model. We performed 3D reconstruction using patients' CT images and superimposed the fracture model onto the standard model for drawing fracture lines. Subsequently, we converted the fracture lines into a heat map for visualization. Additionally, we measured 20 specimens to determine the boundary for various ligaments attached to the talus. We determined the surface area of the talus available for different surgical approaches by integrating the boundary data with previously reported data on area of exposure.
Without considering the displacement distance of the fracture, fracture types were classified as follows, by combining Hawkins and Sneppen classifications: talar neck, 41.3%; posterior talar tubercle, 22.2%; body for the talus and comminuted, 17.5%; lateral talar tubercle, 11.9%; and talar head, 7.1%. We established fracture line and heat maps using this classification. Additionally, we demonstrated the available area for anteromedial, anterolateral, posteromedial, posterolateral, and medial malleolus osteotomy and Chaput osteotomy approaches.
Fracture line and heat map analyses can aid surgeons in planning a single or combined surgical approach for the reduction and internal fixation of talus fractures. Demonstrating the different surgical approaches can help surgeons choose the most effective technique for individual cases.
距骨是踝关节的重要组成部分，其损伤后的治疗至关重要。然而，由于传统分类不完整，仍可能出现并发症和不良事件，这些分类未能从三维角度分析骨折的模式和分布。因此，在本研究中，我们旨在使用三维（3D）和热图技术分析不同类型距骨骨折的骨折线位置和分布。此外，我们旨在确定可用于不同内固定入路的距骨表面积，以辅助手术计划。
我们回顾性分析了我院两家医院收治的 126 例距骨骨折患者的 CT 扫描数据。我们提取了一名健康成年人的 CT 数据，并创建了一个标准距骨模型。我们使用患者的 CT 图像进行 3D 重建，并将骨折模型叠加到标准模型上以绘制骨折线。随后，我们将骨折线转换为热图进行可视化。此外，我们还测量了 20 个标本，以确定与距骨相连的各种韧带的边界。我们将边界数据与之前报道的暴露面积数据相结合，确定了不同手术入路可利用的距骨表面积。
不考虑骨折的移位距离，结合 Hawkins 和 Sneppen 分类，骨折类型如下：距骨颈 41.3%，距骨后结节 22.2%，距骨体及粉碎性骨折 17.5%，外距骨结节 11.9%，距骨头 7.1%。我们使用这种分类方法建立了骨折线和热图。此外，我们还展示了前内侧、前外侧、后内侧、后外侧和内踝截骨及 Chaput 截骨入路的可用面积。
骨折线和热图分析可以帮助外科医生规划单一或联合手术入路，以实现距骨骨折的复位和内固定。展示不同的手术入路可以帮助外科医生为个别病例选择最有效的技术。
