Abstract

BackgroundThe study aimed to analyze the role of axial view in different phases of treatment and demonstrate whether axial view is still useful in evaluating the calcaneal fractures.Methods156 patients with suspected unilateral calcaneal fractures were enrolled in the study, axial and lateral view of the affected foot and single axial view of the unaffected foot were gained. 16 were excluded due to unsatisfying axial radiograph. The remain 140 patients were eventually included into the study. Two separate assessments were conducted on two occasions with a three weeks interval to diagnose fractures. Lateral views were assessed firstly, and lateral combined with axial views were assessed three weeks later. Each of the 140 sets was evaluated by one of 6 surgeons randomly. Sensitivity and specificity value were compared between the two assessments. A new value Z which can directly reflect the degree of bulge on the calcaneal lateral wall on the axial view were introduced into the study. Z value of the 140 unaffected feet were measured. Data of another group of 31 patients who confirmed their lateral hindfoot pain caused by widening of calcaneus was reviewed. Liner regression was employed to analyze the relationship between angle Z and the severity of lateral pain.ResultsAccording to the two assessments, without axial view, specificity value will be significantly lower in diagnosing calcaneal fractures (p = 0.024) and sensitivity value will be significantly lower in distinguishing intra-articular fractures (p < 0.001). The normal threshold of angle Z was estimated from 98.06° to 100.64° (p <0.001). Liner regression shows that the lateral hindfoot pain will obviously aggravate along with the increasing of angle Z value (p <0.001).ConclusionsAxial view is useful in diagnosing a patient with suspected calcaneal fracture especially for distinguishing intra-articular fractures and selection for CT scan. With the introduction of angle Z, axial view can get excellent performance in intra-operative assessment as well as in post-operative follow up procedure. Axial view can still play an irreplaceable role in assessing and evaluating calcaneal fractures, and can be employed as an essential reference during surgical procedure .Electronic supplementary materialThe online version of this article (doi:10.1186/s12893-015-0004-6) contains supplementary material, which is available to authorized users.

Highlights

  • The study aimed to analyze the role of axial view in different phases of treatment and demonstrate whether axial view is still useful in evaluating the calcaneal fractures

  • Does axial view still has an unique role in current treatment process of calcaneal fractures or just an out of fashion technique which should be abandoned? We conduct the study to test the value of axial view in diagnosing calcaneal fracture and in differentiating intra and extra-articular fracture by analyze the sensitivity and specificity

  • We introduce a new value angle Z into the study to evaluate the bulging of calcaneus on axial

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Summary

Introduction

The study aimed to analyze the role of axial view in different phases of treatment and demonstrate whether axial view is still useful in evaluating the calcaneal fractures. Lateral and axial views are the standard plain radiographs in assessing calcaneal fractures in each phase of the treatment [5]. Lateral view has gained popularity in diagnosis of calcaneal injury [6]. We conduct the study to test the value of axial view in diagnosing calcaneal fracture and in differentiating intra and extra-articular fracture by analyze the sensitivity and specificity. The other aim of the current study is identify the normal threshold of angle Z, and further demonstrate the relationship between Z angle and lateral hindfoot pain caused by calcaneal fractures

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