Bohler’s angle’s role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study

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• 作者：Yanling Su (9)
  Wei Chen (9)
  Tao Zhang (9)
  Xingwang Wu (9)
  Zhanpo Wu (9)
  Yingze Zhang (9)
  
• 关键词：Calcaneus ; Displaced intra ; articular fracture ; B?hler’s angle ; Functional outcome ; Sanders classification
• 刊名：BMC Surgery
• 出版年：2013
• 出版时间：December 2013
• 年：2013
• 卷：13
• 期：1
• 全文大小：241 KB
• 参考文献：1. Sanders R: Displaced intra-articular fractures of the calcaneus. / J Bone Joint Surg Am 2000,82(2):225-50.
  2. Zwipp H, Rammelt S, Barthel S: Fracture of the calcaneus. / Unfallchirurg 2005,108(9):737-47. quiz 48 CrossRef
  3. Potter MQ, Nunley JA: Long-term functional outcomes after operative treatment for intra-articular fractures of the calcaneus. / J Bone Joint Surg Am 2009,91(8):1854-860. CrossRef
  4. Rak V, Ira D, Masek M: Operative treatment of intra-articular calcaneal fractures with calcaneal plates and its complications. / Indian J Orthop 2009,43(3):271-80. CrossRef
  5. Bohler L: Diagnosis, pathology, and treatment of fractures of the os calcis. / J Bone Joint Surg Am 1931,13(1):75-9.
  6. Parkes JC 2nd: The nonreductive treatment for fractures of the Os calcis. / Orthop Clin North Am 1973,4(1):193-95.
  7. Leung KS, Chan WS, Shen WY, Pak PP, So WS, Leung PC: Operative treatment of intraarticular fractures of the os calcis–the role of rigid internal fixation and primary bone grafting: preliminary results. / J Orthop Trauma 1989,3(3):232-40. CrossRef
  8. Eastwood DM, Langkamer VG, Atkins RM: Intra-articular fractures of the calcaneum. Part II: Open reduction and internal fixation by the extended lateral transcalcaneal approach. / J Bone Joint Surg Br 1993,75(2):189-95.
  9. Johnson EE, Gebhardt JS: Surgical management of calcaneal fractures using bilateral incisions and minimal internal fixation. / Clin Orthop Relat Res 1993, 290:117-24.
  10. O’Farrell DA, O’Byrne JM, McCabe JP, Stephens MM: Fractures of the os calcis: improved results with internal fixation. / Injury 1993,24(4):263-65. CrossRef
  11. Maskill JD, Bohay DR, Anderson JG: Calcaneus fractures: a review article. / Foot Ankle Clin 2005,10(3):463-89. vi CrossRef
  12. Hyer CF, Atway S, Berlet GC, Lee TH: Early weight bearing of calcaneal fractures fixated with locked plates: a radiographic review. / Foot Ankle Spec 2010,3(6):320-23. CrossRef
  13. Loucks C, Buckley R: Bohler’s angle: correlation with outcome in displaced intra-articular calcaneal fractures. / J Orthop Trauma 1999,13(8):554-58. CrossRef
  14. Ibrahim T, Rowsell M, Rennie W, Brown AR, Taylor GJ, Gregg PJ: Displaced intra-articular calcaneal fractures: 15-year follow-up of a randomised controlled trial of conservative versus operative treatment. / Injury 2007,38(7):848-55. CrossRef
  15. Wang Q, Chen W, Su Y, Pan J, Zhang Q, Peng A, Wu X, Wang P, Zhang Y: Minimally invasive treatment of calcaneal fracture by percutaneous leverage, anatomical plate, and compression bolts–the clinical evaluation of cohort of 156 patients. / J Trauma 2010,69(6):1515-522. CrossRef
  16. Wu Z, Su Y, Chen W, Zhang Q, Liu Y, Li M, Wang H, Zhang Y: Functional outcome of displaced intra-articular calcaneal fractures: a comparison between open reduction/internal fixation and a minimally invasive approach featured an anatomical plate and compression bolts. / J Trauma Acute Care Surg 2012,73(3):743-51. CrossRef
  17. Schepers T, van Lieshout EM, van Ginhoven TM, Heetveld MJ, Patka P: Current concepts in the treatment of intra-articular calcaneal fractures: results of a nationwide survey. / Int Orthop 2008,32(5):711-15. CrossRef
  18. Ratner B: / Statistical Modeling and Analysis for Database Marketing: Effective Techniques for Mining Big Data. New York: Taylor & Francis; 2003. CrossRef
  19. Mitchell MJ, McKinley JC, Robinson CM: The epidemiology of calcaneal fractures. / Foot (Edinb) 2009,19(4):197-00. CrossRef
  20. Buckley RE, Tough S: Displaced intra-articular calcaneal fractures. / J Am Acad Orthop Surg 2004,12(3):172-78.
  21. Buckley RE, Meek RN: Comparison of open versus closed reduction of intraarticular calcaneal fractures: a matched cohort in workmen. / J Orthop Trauma 1992,6(2):216-22. CrossRef
  22. Hutchinson F 3rd, Huebner MK: Treatment of os calcis fractures by open reduction and internal fixation. / Foot Ankle Int 1994,15(5):225-32. CrossRef
  23. Pozo JL, Kirwan EO, Jackson AM: The long-term results of conservative management of severely displaced fractures of the calcaneus. / J Bone Joint Surg Br 1984,66(3):386-90.
  24. Makki D, Alnajjar HM, Walkay S, Ramkumar U, Watson AJ, Allen PW: Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases. / J Bone Joint Surg Br 2010,92(5):693-00.
  25. Paul M, Peter R, Hoffmeyer P: Fractures of the calcaneum. A review of 70 patients. / J Bone Joint Surg Br 2004,86(8):1142-145. CrossRef
  26. Kundel K, Funk E, Brutscher M, Bickel R: Calcaneal fractures: operative versus nonoperative treatment. / J Trauma 1996,41(5):839-45. CrossRef
  27. Parmar HV, Triffitt PD, Gregg PJ: Intra-articular fractures of the calcaneum treated operatively or conservatively. A prospective study. / J Bone Joint Surg Br 1993,75(6):932-37.
  28. Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, Galpin R: Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. / J Bone Joint Surg Am 2002,84-A(10):1733-744.
  29. Letournel E: Open treatment of acute calcaneal fractures. / Clin Orthop Relat Res 1993, 290:60-7.
  30. Janzen DL, Connell DG, Munk PL, Buckley RE, Meek RN, Schechter MT: Intraarticular fractures of the calcaneus: value of CT findings in determining prognosis. / AJR Am J Roentgenol 1992,158(6):1271-274. CrossRef
  31. Paley D, Hall H: Intra-articular fractures of the calcaneus. A critical analysis of results and prognostic factors. / J Bone Joint Surg Am 1993,75(3):342-54.
  32. Mauffrey C, Klutts P, Seligson D: The use of circular fine wire frames for the treatment of displaced intra-articular calcaneal fractures. / J Orthop Traumatol 2009,10(1):9-5. CrossRef
  33. Shuler FD, Conti SF, Gruen GS, Abidi NA: Wound-healing risk factors after open reduction and internal fixation of calcaneal fractures: does correction of Bohler’s angle alter outcomes? / Orthop Clin North Am 2001,32(1):187-92. x CrossRef
  34. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2482/13/40/prepub
  
• 作者单位：Yanling Su (9)
  Wei Chen (9)
  Tao Zhang (9)
  Xingwang Wu (9)
  Zhanpo Wu (9)
  Yingze Zhang (9)
  
  9. Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, 050051, PR China
  
• ISSN：1471-2482

文摘

Background Controversy exits over the role of B?hler’s angle in assessing the injury severity of displaced intra-articular calcaneal fractures and predicting the functional outcome following internal fixation. This study aims to investigate whether a correlation exists between B?hler’s angle and the injury severity of displaced calcaneal fractures, and between surgical improvement of B?hler’s angle and functional outcome. Methods Patients treated operatively for unilateral closed displaced intra-articular calcaneal fractures from January 1, 2004 to March 31, 2008 were identified. The B?hler’s angles of both calcaneus were measured, and the measurement of the uninjured foot was used as its normal control. The difference in the value of B?hler’s angle measured preoperatively or postoperatively between the angle of the injured foot and that of the contralateral calcaneus were calculated, respectively. The change in B?hler’s angle by ratio was calculated by dividing the difference value of B?hler’s angle between bilateral calcaneus by its normal control. The injury severity was assessed according to Sanders classification. The functional outcomes were assessed using American Orthopaedic Foot & Ankle Society hindfoot scores. Results 274 patients were included into the study with a mean follow-up duration of 71 months. According to Sanders classification, the fracture pattern included 105 type II, 121 type III and 48 type IV fractures. According to American Orthopaedic Foot & Ankle Society hindfoot scoring system, the excellent, good, fair and poor results were achieved in 104, 132, 27, and 11 patients, respectively. The preoperative B?hler’s angle, difference value of B?hler’s angle between bilateral calcaneus, and change in B?hler’s angle by ratio each has a significant correlation with Sanders classification (rs=?.178, P=0.003; rs=?.174, P=0.004; rs=?.172, P=0.005, respectively), however, is not correlated with functional outcome individually. The three postoperative measurements were all found to have a significant correlation with American Orthopaedic Foot & Ankle Society hindfoot scores (rs=0.223, P<0.001; rs=0.224, P<0.001; rs=0.220, P<0.001, respectively). However, these correlations were all weak to low. Conclusions There was a significant correlation between preoperative B?hler’s angle and the injury severity of displaced intra-articular calcaneal fractures, but only postoperative B?hler’s angle parameters were found to have a significant correlation with the functional recovery.