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Fracture energy of calcaneal fractures positively correlated with Sanders classification
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The positive correlation of fracture energy with Sanders classification for displaced intra-articular calcaneal fractures may be used to identify more severe fractures at greater risk of post-traumatic osteoarthritis, according to published results.
Donald D. Anderson, PhD, and colleagues used preoperative CT scans to grade 48 displaced intra-articular calcaneal fractures in 36 patients according to the Sanders classification and to quantify fracture severity. Researchers also objectively quantified fracture severity using a CT-based measure of fracture energy and assessed post-traumatic osteoarthritis with the Kellgren-Lawrence scale on follow-up radiographs. The SF-36 questionnaire and VAS pain score were used to assess patient outcomes.
Results showed fracture energies ranged from 14.1 J to 26.2 J, with a statistically significant positive linear correlation between Sanders classification and mean fracture energy. Fractures in which the subtalar joint developed post-traumatic OA had higher fracture energies compared with those that did not, according to results. However, researchers found the difference did not reach statistical significance. Researchers noted post-traumatic OA risk was predicted by Sanders classification. Although a correlation was found between high fracture energy and lower SF-36 scores, researchers did not find a relationship between fracture energy and VAS pain scores.
“In prior studies, we found that fracture severity (energy) correlates with post-traumatic osteoarthritis (PTOA) risk in tibial pilon fractures, a finding that points to potential prognostic value. Consistent with clinical experience, this study found that the energy range for displaced intra-articular calcaneal fractures was narrower and focused more on the upper end of the spectrum compared with pilon fractures,” Anderson told Healio.com/Orthopedics. “Fracture energy correlated with Sanders classification, but the association of fracture energy with PTOA was not as strong as it was in the tibial pilon. This suggests that other factors, perhaps related to the specific personality of the fracture or to the articular reduction obtained, more strongly influence PTOA risk for intra-articular calcaneal fractures.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
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