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Does axial view still play an important role in dealing with calcaneal fractures?

Zhang T, Chen W, Su Y, Wang H, Zhang Y - BMC Surg (2015)

Bottom Line: Sensitivity and specificity value were compared between the two assessments.Liner regression shows that the lateral hindfoot pain will obviously aggravate along with the increasing of angle Z value (p <0.001).With the introduction of angle Z, axial view can get excellent performance in intra-operative assessment as well as in post-operative follow up procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P R China. pc50500tao@gmail.com.cn.

ABSTRACT

Background: The study aimed to analyze the role of axial view in different phases of treatment and demonstrate whether axial view is still useful in evaluating the calcaneal fractures.

Methods: 156 patients with suspected unilateral calcaneal fractures were enrolled in the study, axial and lateral view of the affected foot and single axial view of the unaffected foot were gained. 16 were excluded due to unsatisfying axial radiograph. The remain 140 patients were eventually included into the study. Two separate assessments were conducted on two occasions with a three weeks interval to diagnose fractures. Lateral views were assessed firstly, and lateral combined with axial views were assessed three weeks later. Each of the 140 sets was evaluated by one of 6 surgeons randomly. Sensitivity and specificity value were compared between the two assessments. A new value Z which can directly reflect the degree of bulge on the calcaneal lateral wall on the axial view were introduced into the study. Z value of the 140 unaffected feet were measured. Data of another group of 31 patients who confirmed their lateral hindfoot pain caused by widening of calcaneus was reviewed. Liner regression was employed to analyze the relationship between angle Z and the severity of lateral pain.

Results: According to the two assessments, without axial view, specificity value will be significantly lower in diagnosing calcaneal fractures (p = 0.024) and sensitivity value will be significantly lower in distinguishing intra-articular fractures (p < 0.001). The normal threshold of angle Z was estimated from 98.06° to 100.64° (p <0.001). Liner regression shows that the lateral hindfoot pain will obviously aggravate along with the increasing of angle Z value (p <0.001).

Conclusions: Axial view is useful in diagnosing a patient with suspected calcaneal fracture especially for distinguishing intra-articular fractures and selection for CT scan. With the introduction of angle Z, axial view can get excellent performance in intra-operative assessment as well as in post-operative follow up procedure. Axial view can still play an irreplaceable role in assessing and evaluating calcaneal fractures, and can be employed as an essential reference during surgical procedure .

No MeSH data available.


Related in: MedlinePlus

Experiment on lower limb specimen. A) The peroneal tendon sheath lay between retinaculum musculorum peroneorum superius and retinaculum musculorum peronaeorum inferius was exposed. B) A bicortical hole located below lateral malleolus and proximal to retinaculum musculorum peronaeorum inferius is made by the drill. The drill introduce through peroneal tendon sheath and perpendicular to the lateral wall. C) Screw was placed with a metal gasket. D) The gasket can cover majority of the tendon sheath below lateral malleolus.
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Fig3: Experiment on lower limb specimen. A) The peroneal tendon sheath lay between retinaculum musculorum peroneorum superius and retinaculum musculorum peronaeorum inferius was exposed. B) A bicortical hole located below lateral malleolus and proximal to retinaculum musculorum peronaeorum inferius is made by the drill. The drill introduce through peroneal tendon sheath and perpendicular to the lateral wall. C) Screw was placed with a metal gasket. D) The gasket can cover majority of the tendon sheath below lateral malleolus.

Mentions: Can more information be gained from axial view? or it just supposed to be abandoned? We design the current study as an ongoing part of our former research [17] aim to figure out whether the axial view is still useful. As compression on the peroneal tendons caused by malunion of calcaneal fracture has been demonstrated to have a definite relationship with lateral pain, we introduced a measurable value - Angle Z in the current study to test the efficiency of axial view. The new value was born in a experiment on a limb specimen which was donated by an amputee suffered with malignant neoplasm of lower limb. The specimen was fixed on the operating table with the lateral malleolus facing up. An arc incision was made below lateral malleolus by a scalpel along the course of peroneal tendon sheath. Exposed the peroneal tendon sheath lay between retinaculum musculorum peroneorum superius and retinaculum musculorum peronaeorum inferius. Drill a bicortical hole located below lateral malleolus and proximal to retinaculum musculorum peronaeorum inferius. Drill should be introduced through peroneal tendon sheath and perpendicular to the lateral wall. Screw was placed with a metal gasket, and then the gasket can cover majority of the tendon sheath below lateral malleolus (Figure 3). An axial radiography of the experimental calcaneus was taken as the last step. Axial view showed that central point of the gasket just located on the parallel line (β) of subtalar joint below sustentaculum tali level (Figure 4). It revealed that bulging of the calcaneal lateral wall at line β level can directly reflect severity of irritation on peroneal tendon sheath. In addition, the sustentaculum tali suppose to be the most stable part of the calcaneus, since it is connected to the talus via strong medial and lateral talocalcaneal ligaments [18,19]. Therefore, we create the new value (angle Z) which can efficiently reflect degree of lateral wall bulging at line β level and try to demonstrate increasing of angle Z has a relationship to poor outcomes.Figure 3


Does axial view still play an important role in dealing with calcaneal fractures?

Zhang T, Chen W, Su Y, Wang H, Zhang Y - BMC Surg (2015)

Experiment on lower limb specimen. A) The peroneal tendon sheath lay between retinaculum musculorum peroneorum superius and retinaculum musculorum peronaeorum inferius was exposed. B) A bicortical hole located below lateral malleolus and proximal to retinaculum musculorum peronaeorum inferius is made by the drill. The drill introduce through peroneal tendon sheath and perpendicular to the lateral wall. C) Screw was placed with a metal gasket. D) The gasket can cover majority of the tendon sheath below lateral malleolus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359527&req=5

Fig3: Experiment on lower limb specimen. A) The peroneal tendon sheath lay between retinaculum musculorum peroneorum superius and retinaculum musculorum peronaeorum inferius was exposed. B) A bicortical hole located below lateral malleolus and proximal to retinaculum musculorum peronaeorum inferius is made by the drill. The drill introduce through peroneal tendon sheath and perpendicular to the lateral wall. C) Screw was placed with a metal gasket. D) The gasket can cover majority of the tendon sheath below lateral malleolus.
Mentions: Can more information be gained from axial view? or it just supposed to be abandoned? We design the current study as an ongoing part of our former research [17] aim to figure out whether the axial view is still useful. As compression on the peroneal tendons caused by malunion of calcaneal fracture has been demonstrated to have a definite relationship with lateral pain, we introduced a measurable value - Angle Z in the current study to test the efficiency of axial view. The new value was born in a experiment on a limb specimen which was donated by an amputee suffered with malignant neoplasm of lower limb. The specimen was fixed on the operating table with the lateral malleolus facing up. An arc incision was made below lateral malleolus by a scalpel along the course of peroneal tendon sheath. Exposed the peroneal tendon sheath lay between retinaculum musculorum peroneorum superius and retinaculum musculorum peronaeorum inferius. Drill a bicortical hole located below lateral malleolus and proximal to retinaculum musculorum peronaeorum inferius. Drill should be introduced through peroneal tendon sheath and perpendicular to the lateral wall. Screw was placed with a metal gasket, and then the gasket can cover majority of the tendon sheath below lateral malleolus (Figure 3). An axial radiography of the experimental calcaneus was taken as the last step. Axial view showed that central point of the gasket just located on the parallel line (β) of subtalar joint below sustentaculum tali level (Figure 4). It revealed that bulging of the calcaneal lateral wall at line β level can directly reflect severity of irritation on peroneal tendon sheath. In addition, the sustentaculum tali suppose to be the most stable part of the calcaneus, since it is connected to the talus via strong medial and lateral talocalcaneal ligaments [18,19]. Therefore, we create the new value (angle Z) which can efficiently reflect degree of lateral wall bulging at line β level and try to demonstrate increasing of angle Z has a relationship to poor outcomes.Figure 3

Bottom Line: Sensitivity and specificity value were compared between the two assessments.Liner regression shows that the lateral hindfoot pain will obviously aggravate along with the increasing of angle Z value (p <0.001).With the introduction of angle Z, axial view can get excellent performance in intra-operative assessment as well as in post-operative follow up procedure.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedic Surgery, the Third Hospital of Hebei Medical University, NO.139 Ziqiang Road, Shijiazhuang, 050051, P R China. pc50500tao@gmail.com.cn.

ABSTRACT

Background: The study aimed to analyze the role of axial view in different phases of treatment and demonstrate whether axial view is still useful in evaluating the calcaneal fractures.

Methods: 156 patients with suspected unilateral calcaneal fractures were enrolled in the study, axial and lateral view of the affected foot and single axial view of the unaffected foot were gained. 16 were excluded due to unsatisfying axial radiograph. The remain 140 patients were eventually included into the study. Two separate assessments were conducted on two occasions with a three weeks interval to diagnose fractures. Lateral views were assessed firstly, and lateral combined with axial views were assessed three weeks later. Each of the 140 sets was evaluated by one of 6 surgeons randomly. Sensitivity and specificity value were compared between the two assessments. A new value Z which can directly reflect the degree of bulge on the calcaneal lateral wall on the axial view were introduced into the study. Z value of the 140 unaffected feet were measured. Data of another group of 31 patients who confirmed their lateral hindfoot pain caused by widening of calcaneus was reviewed. Liner regression was employed to analyze the relationship between angle Z and the severity of lateral pain.

Results: According to the two assessments, without axial view, specificity value will be significantly lower in diagnosing calcaneal fractures (p = 0.024) and sensitivity value will be significantly lower in distinguishing intra-articular fractures (p < 0.001). The normal threshold of angle Z was estimated from 98.06° to 100.64° (p <0.001). Liner regression shows that the lateral hindfoot pain will obviously aggravate along with the increasing of angle Z value (p <0.001).

Conclusions: Axial view is useful in diagnosing a patient with suspected calcaneal fracture especially for distinguishing intra-articular fractures and selection for CT scan. With the introduction of angle Z, axial view can get excellent performance in intra-operative assessment as well as in post-operative follow up procedure. Axial view can still play an irreplaceable role in assessing and evaluating calcaneal fractures, and can be employed as an essential reference during surgical procedure .

No MeSH data available.


Related in: MedlinePlus