Zhang Yuanzhen, Liu Jiayun, Yang Jinhua, Yuan Ye, Yin Guoyong, Zhang Yu, Lu Chun
The First Affiliated Hospital with Nanjing Medical University, 300 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
Quality Management Office, The Fourth Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, 210000, China.
J Orthop Surg Res. 2025 May 30;20(1):546. doi: 10.1186/s13018-025-05934-6.
Calcaneal fractures usually arise from high-energy trauma and predominantly impact young individuals. In older adults (aged ≥ 50 years), declining bone density and muscle strength increase fracture risk from low-energy trauma, leading to a bimodal epidemiological distribution. The intricacies of calcaneal fractures in older adults, alongside osteoporosis and soft tissue fragility, complicate surgical intervention. This study aims to analyze age-related differences in calcaneal fracture characteristics using three-dimensional(3D) mapping and assess their impact on medial incision design.
A total of 95 patients with closed calcaneal fractures were categorized into two groups: Younger (< 50 years, n = 61) and Older (≥ 50 years, n = 34). The process of 3D fracture mapping was executed utilizing Mimics and 3-matic software, alongside the reconstruction of soft tissue, which encompassed the posterior tibial neurovascular bundle. Differences in fracture distribution and incision parameters (length, α angle, D1, and D2) were statistically analyzed, with p < 0.05 considered statistically significant.
Fracture lines in both groups were predominantly located around the lateral Gissane's angle and critical weight-bearing areas of the calcaneus. In the Younger Group, fracture lines were long, continuous, and involved fewer fragments, correlating with high-energy trauma. The Older Group showed more comminuted lines, characteristic of osteoporotic fractures. The α angle and D1 distance were significantly smaller in the Older Group (p < 0.05), indicating closer proximity to the medial malleolus. D2 values were also smaller (p < 0.05), with 48.65% intersecting the neurovascular bundle compared to 31.34% in the Younger Group.
Age significantly influences medial wall fracture patterns and complexity in calcaneal injuries. A personalized medial incision based on fracture morphology provides better exposure and reduction compared to traditional methods. Although the incision is closer to the neurovascular bundle in older patients, meticulous surgical technique guarantees safety. The integration of a medial incision with sinus-tarsi (ST) approach minimizes the necessity for extensive lateral exposure, thereby diminishing soft tissue complications and improving surgical outcomes for the elderly population.
Level IV, retrospective case series.
跟骨骨折通常由高能量创伤引起，主要影响年轻人。在老年人（年龄≥50岁）中，骨密度和肌肉力量的下降增加了低能量创伤导致骨折的风险，从而导致双峰式的流行病学分布。老年人跟骨骨折的复杂性，以及骨质疏松和软组织脆弱性，使手术干预变得复杂。本研究旨在使用三维（3D）映射分析跟骨骨折特征的年龄相关差异，并评估其对内侧切口设计的影响。
总共95例闭合性跟骨骨折患者被分为两组：较年轻组（<50岁，n = 61）和较年长组（≥50岁，n = 34）。利用Mimics和3-matic软件执行3D骨折映射过程，同时重建包括胫后神经血管束在内的软组织。对骨折分布和切口参数（长度、α角、D1和D2）的差异进行统计学分析，p < 0.05被认为具有统计学意义。
两组的骨折线主要位于跟骨外侧的吉氏角和关键负重区域周围。在较年轻组中，骨折线长、连续且涉及的碎片较少，这与高能量创伤相关。较年长组显示出更多的粉碎性骨折线，这是骨质疏松性骨折的特征。较年长组的α角和D1距离明显更小（p < 0.05），表明更靠近内踝。D2值也更小（p < 0.05），较年长组有48.65%的骨折线与神经血管束相交，而较年轻组为31.34%。
年龄显著影响跟骨损伤的内侧壁骨折模式和复杂性。与传统方法相比，基于骨折形态的个性化内侧切口能提供更好的暴露和复位。尽管老年患者的切口更靠近神经血管束，但细致的手术技术可确保安全。内侧切口与距下窦（ST）入路相结合可最大限度减少广泛外侧暴露的必要性，从而减少软组织并发症并改善老年患者的手术效果。
IV级，回顾性病例系列。
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