Surgically treated calcaneal joint fractures: What does postoperative computed tomography give us?

Abstract

IntroductionThere is currently great controversy about the ideal treatment of intraarticular calcaneal fractures. The objective of this study is to determine the usefulness of postoperative computed tomography (CT). Material and MethodsWe conducted a retrospective descriptive study of patients operated on in the period 2007–2015 in our center. Epidemiological variables, specific fracture data, surgical intervention as well as results and complications were collected. The radiological evaluation was performed using simple radiology (Böhler angle) and coronal CT (congruence of posterior subtalar joint). For the functional results we use the AOFAS hindfoot scale and the EVA scale for the level of pain. ResultsWe included 46 fractures in 43 patients (3 bilateral). 35 were male and 8 female, with an average age of 42 years (18−79) and an average follow-up of 57.39 months (33–129). Preoperative CT was performed in all cases, of which 11 were Sanders II, 23 type III and 12 type IV. Postoperative CT was only performed in 17 cases. The subsequent subtalar reduction measured by CT was satisfactory (articular step <2 mm) in 12 cases. The average presurgical Böhler angle was 6.45 ± 10.21 (-22−25) and the post-surgical angle of 20.46 ± 7.09 (4−38). Subtalar osteoarthritis developed in 19 cases (symptomatic in 12) and calcaneo-cuboid osteoarthritis in 6 cases (only 1 symptomatic). The AOFAS was 74.28 ± 18.98 (27−100) and the EVA was 4.14 ± 2.98 (2–9). A CT scan with a step of less than 2 mm was statistically significant, with a higher result on the AOFAS scale (77.17 average points) as well as lower EVA on average (2.83) (p = 0.002). Regarding the Böhler, it was statistically significant the relationship of an angle> 20° post-surgical with higher AOFAS (80.82) and lower VAS (3.18) (p = 0.001). The literature search obtained a total of 117 articles that met the search criteria, of which only 29 requested postoperative CT. ConclusionsThe indication of postoperative CT in patients operated by intraarticular calcaneal fracture is the best technique to corroborate the correct reduction of the subtalar joint surface, although it is not universally accepted, according to the literature.