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Fracture energy, Sanders classification, and articular step-off are linked with subsequent post-traumatic osteoarthritis (PTOA).
According to the evidence from a
recently published retrospective review and fracture severity analysis, a
positive association was found between fracture energy and the Sanders
classification for dislodged intra-articular calcaneal fractures (DIACFs),
which can be employed to detect more severe fractures at higher risk for
growing to post-traumatic osteoarthritis (PTOA).
A total of 36 participants with
48 DIACFs, ≥ 18 years old, with good quality post-op and follow up radiographs,
electronic pre-op and post-op CT scans, and a follow up ≥ 18 months were chosen
from previously treated 153 patients. Treatment of these fractures was done
with percutaneous reduction with multiple small stab incisions and fluoroscopy
to oversee manipulation of articular fragments ( with corkscrews or Steinmann
pins) with subsequent fixation using 3.5- and 4.0 mm screws. Pre-op CT scans
rank the fractures as per the Sanders classification and quantify the severity
of the fractures. Further, a CT-based measure of fracture energy performed to
quantify the fracture severity objectively. Assessment of PTOA on follow up
radiographs was done using the Kellgren-Lawrence scale. Pain and functional
outcomes were evaluated using the visual analogue scale pain score and the
Short Form 36 (SF-36).
The 48 DIACFs ranked from 14.1
to 26.2 J and associated with Sanders classification; type I; type II; type
III; type IV. Fractures with subtalar joint produced PTOA exhibited higher
fracture energy as compared to those that did not; however, the difference did
not attain statistical significance. PTOA risk is prophesied using the Sanders
classification. VAS pain and fracture energy presented no associations, whereas
lower SF-36 scores showed an association with higher fracture energy. Positive
association of Sanders classification for DIACFs with fracture energy can be
utilised to discover more severe fractures at higher risk for growing to PTOA.
J Orthop Trauma.
Correlation of Fracture Energy with Sanders Classification and Post-Traumatic Osteoarthritis following Displaced Intra-Articular Calcaneus Fractures.
Karan Rao et al.
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