Steelman Kevin R, Brenner Joseph, Purushotham Anagha, Joiner Jonathan, Meehan Robert, Vaidya Rahul
Department of Orthopaedic Surgery, Trinity Health Medical Group, Grand Rapids, MI.
University of Toledo College of Medicine and Life Sciences, Toledo, OH.
OTA Int. 2025 Jun 26;8(3):e412. doi: 10.1097/OI9.0000000000000412. eCollection 2025 Sep.
To evaluate calcaneal tuber length (TL) and its influence on calcaneal height (CH), talar declination angle (TDA), and function during plantarflexion after operative fixation of calcaneus fractures.
Retrospective case-control study.
Large, urban, level 1 trauma center.
PATIENTS/PARTICIPANTS: A total of 39 patients from 2012 to 2022 with isolated intra-articular calcaneus fractures with weight-bearing lateral postoperative and contralateral x-rays (to use as internal control) with at least 1 year follow up.
Patients underwent fixation of calcaneus fractures and were separated into "short tuber" (ST) and "restored tuber" (RT) groups. Postoperative radiographs were compared with contralateral radiographs.
Calcaneal Bohler angle (BA), TL, CH, TDA, and relative work increase using the equation Work = Force × Distance. Fixation methods related to TL were also investigated.
Overall, 37 of 39 patients (95%) had postoperative BA within 20-40°. 8 of 39 patients were in the ST group, and 31 of 39 were in the RT group. The average TL difference was 0.73 cm in ST versus 0.13 cm in RT ( < 0.01). The average CH difference was 0.46 cm in ST versus 0.28 cm in RT ( = 0.04). The average TDA difference was 9.9° in ST (flatter) versus 2.6° in RT ( = 0.024). The average work increase to plantarflex the ankle was 12.1% in ST versus 2.2% in RT ( < 0.01). Open fixation resulted in shorter TLs compared with the contralateral side ( = 0.02), but percutaneous fixation did not ( = 0.17).
Despite restoring BA, presence of a shortened tuber can still result in decreased CH and a flat talus compared with the contralateral limb. It also required increased work to plantarflex the ankle, further highlighting the importance of restoring tuber length.
IV.
评估跟骨结节长度（TL）及其对跟骨高度（CH）、距骨倾斜角（TDA）以及跟骨骨折手术固定后跖屈功能的影响。
回顾性病例对照研究。
大型城市一级创伤中心。
患者/参与者：2012年至2022年期间共有39例孤立性关节内跟骨骨折患者，术后负重位患侧及对侧X线片（用作内部对照），随访至少1年。
患者接受跟骨骨折固定，并分为“短结节”（ST）组和“恢复结节”（RT）组。将术后X线片与对侧X线片进行比较。
跟骨Bohler角（BA）、TL、CH、TDA以及使用公式“功 = 力×距离”计算的相对功增加量。还研究了与TL相关的固定方法。
总体而言，39例患者中有37例（95%）术后BA在20°至40°之间。39例患者中8例在ST组，31例在RT组。ST组的平均TL差异为0.73 cm，而RT组为0.13 cm（P < 0.01）。ST组的平均CH差异为0.46 cm，而RT组为0.28 cm（P = 0.04）。ST组的平均TDA差异为9.9°（更扁平），而RT组为2.6°（P = 0.024）。踝关节跖屈的平均功增加量在ST组为12.1%，而在RT组为2.2%（P < 0.01）。与对侧相比，切开复位内固定导致TL缩短（P = 0.02），但经皮固定则未出现这种情况（P = 0.17）。
尽管恢复了BA，但与对侧肢体相比，结节缩短仍可导致CH降低和距骨扁平。踝关节跖屈所需的功也增加，进一步凸显了恢复结节长度的重要性。
IV级。
