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[Calcaneal fractures: CT aspects]
P Sbragia1, G Zanfranceschi, F Niccolai
1Servizio di Radiologia, Ospedale Del Ceppo, Pistoia.
Insights
High-resolution computed tomography (CT) offers superior imaging for calcaneal fractures compared to X-rays. CT accurately visualizes fracture lines, fragment displacement, and joint involvement, aiding treatment planning.
Area of Science:
- Orthopedic surgery
- Radiology
- Medical imaging
Background:
- Calcaneal fractures represent a significant portion of foot and overall fractures.
- Conventional X-rays often lack the detail needed to fully assess complex calcaneal fractures, particularly involving the astragalocalcaneal joint.
- Accurate fracture characterization is crucial for effective treatment planning.
Purpose of the Study:
- To evaluate the utility of high-resolution computed tomography (HRCT) in imaging calcaneal fractures.
- To compare the diagnostic value of CT with conventional X-rays for calcaneal fractures.
- To assess the role of CT in characterizing fracture patterns and fragment displacement.
Main Methods:
- Retrospective analysis of 12 patients with calcaneal fractures diagnosed via conventional X-rays.
- High-resolution CT (HRCT) performed using 3-mm contiguous sections in axial and coronal planes.
- Evaluation of fracture lines, impaction, fragment displacement, and joint involvement.
Main Results:
- CT provided more detailed information than conventional X-rays for calcaneal fractures.
- Fracture patterns included oblique fractures and impaction of the posterior facet.
- CT identified specific findings such as bone fragments in the tarsal sinus, displaced sustentacular fragments, impacted cuboid bone, and tuberosity dislocation.
Conclusions:
- High-resolution CT is superior to conventional X-rays for imaging calcaneal fractures.
- CT plays a fundamental role in accurately evaluating calcaneal fractures for treatment planning.
- The detailed anatomical visualization by CT aids in understanding fracture complexity and guiding surgical decisions.
Abstract:
Calcaneal fractures account for 33.3% of foot fractures and 1.5% of all fractures. They were divided by Warrick and Brenner into two main groups according to whether they modify the astragalocalcaneal joint or not. Given the anatomical complexity of the foot, conventional X-rays are not always able to correctly visualize the articular facets and therefore provide insufficient information as to the characteristics of the fracture line, the position of bone fragments, and the involvement of capsulo-ligamentous structures. The authors report their personal experience with CT in the study of 12 patients with monolateral calcaneal fractures previously diagnosed on conventional X-rays. High-resolution CT (HRCT) was employed with 3-mm contiguous sections on the axial and the coronal planes. CT was used to study the normal anatomy of the foot and to evaluate 3 patients with calcaneal fracture without impaction of the posterior facet; 9 patients with impaction into the calcaneal body were also examined with CT. In the first 3 cases, an oblique fracture line was observed crossing from craniolateral to mediocaudal and thus dividing the calcaneus into 2 large fragments: sustentaculum tali and posterior facet of the talar joint. In the extant 9 cases the impaction of the posterior facet was indicated by an interruption in lateral and/or medial calcaneal walls. In 2/9 cases bone fragments were seen in the tarsal sinus, in 4/9 the sustentacular fragment was displaced, in 2 the cuboid bone was impacted into the anterior process of the calcaneus and, finally, in 7/9 cases a lateral/medial dislocation of the calcaneal tuberosity was observed. On the basis of these results, CT proved to be of greater value than conventional X-rays in the imaging of calcaneal fractures and to have a fundamental role every time an accurate evaluation of the region is needed to plan treatment.