The new intra-articular calcaneal fracture classification system in term of sustentacular fragment configurations and incorporation of posterior calcaneal facet fractures with fracture components of the calcaneal body

Objective The aim of this study was to develop a new calcaneal fracture classification system which will consider sustentacular fragment configuration and relation of posterior calcaneal facet to calcaneal body. Methods The new classification system used sustentacular fragment configuration and relation of posterior calcaneal facet fracture with fracture components of calcaneal body as key aspects of main types and subtypes. Between 2000 and 2014, 126 intraarticular calcaneal fractures were classified according to the new classification system by using computed tomography images. The new classification system was studied in term of reliability, correlation to choices of treatment, implant fixation and quality of fracture reduction. Results Types of sustentacular fragment comprised type A, B and C. Type A sustentacular fragment included sustentacular tali containing middle calcaneal facet. In Type B and C fractures sustentacular fragment included medial aspect and entire posterior calcaneal facet as a single unit, respectively. The fractures with type A, B and C sustentacular fragments were classified as main type A, B and C intra-articular calcaneal fractures. The main type A and B comprised 4 subtypes. Subtypes A1, A3, B1, and B3 associated with avulsion and bending fragments of calcaneal body. Subtype A2, B2, and B4 associated with burst calcaneal body. Subtype B4 was not found in the study. Main type C had no subtype and associated with burst calcaneal body. The data showed good reliability. Conclusion The study showed that our new intra-articular calcaneal fracture classification system correlates to choices of treatment, implant fixation and quality of fracture reduction. Level of Evidence: Level IV, Study of Diagnostic Test

[1]  B. Everitt,et al.  Statistical methods for rates and proportions , 1973 .

[2]  D. Makki,et al.  Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases. , 2010, The Journal of bone and joint surgery. British volume.

[3]  P. Essex-Lopresti.  The mechanism, reduction technique, and results in fractures of the OS calcis , 1952, The British journal of surgery.

[4]  B. Sangeorzan,et al.  Prognostic Value of Computed Tomography Classification Systems for Intra-articular Calcaneus Fractures , 2014, Foot & ankle international.

[5]  P. Essex-Lopresti.  The mechanism, reduction technique, and results in fractures of the os calcis, 1951-52. , 1993, Clinical orthopaedics and related research.

[6]  J. R. Landis,et al.  The measurement of observer agreement for categorical data. , 1977, Biometrics.

[7]  R. Sanders,et al.  Operative Treatment in 120 Displaced Intraarticular Calcaneal Fractures Results Using a Prognostic Computed Tomography Scan Classification , 1993, Clinical orthopaedics and related research.

[8]  S. M. Abdelgaid.  Closed reduction and percutaneous cannulated screws fixation of displaced intra-articular calcaneus fractures. , 2012, Foot and ankle surgery : official journal of the European Society of Foot and Ankle Surgeons.

[9]  K. Wallin,et al.  Evidence-based rationale for percutaneous fixation technique of displaced intra-articular calcaneal fractures: a systematic review of clinical outcomes. , 2014, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[10]  B. Chuckpaiwong,et al.  Displaced articular calcaneus fractures: classification and fracture scores: a preliminary study. , 2012, Journal of the Medical Association of Thailand = Chotmaihet thangphaet.

[11]  T. Harnroongroj,et al.  Measurement technique of calcaneal varus from axial view radiograph , 2015, Indian journal of orthopaedics.

[12]  H. Tscherne,et al.  Osteosynthesis of Displaced Intraarticular Fractures of the Calcaneus Results in 123 Cases , 1993, Clinical orthopaedics and related research.

[13]  I. Gitajn,et al.  Anatomic Alignment and Integrity of the Sustentaculum Tali in Intra-Articular Calcaneal Fractures: Is the Sustentaculum Tali Truly Constant? , 2014, The Journal of bone and joint surgery. American volume.

[14]  P. Mulder,et al.  Calcaneal fracture classification: a comparative study. , 2009, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[15]  J. Fleiss,et al.  Statistical methods for rates and proportions , 1973 .