Classification of calcaneal fractures by spiral computed tomography: implications for surgical treatment

Autor: Ulrich Brunner, Maximilian F. Reiser, Wolf Mutschler, Johannes Rieger, Michael Krötz, Ulrich Linsenmaier, Klaus Jürgen Pfeifer, Alexander Schöning
Rok vydání: 2003
Předmět:
Zdroj: European Radiology. 13:2315-2322
ISSN: 1432-1084
0938-7994
DOI: 10.1007/s00330-003-1888-6
Popis: The purpose of this study was to evaluate spiral computed tomography and multislice CT (SCT/MSCT) with multiplanar reconstructions (MPR) in the classification of calcaneal fractures according to a modified CT classification and to quantify fragment displacement to guide surgical treatment. Forty-eight calcaneal fractures were examined by spiral CT (1- to 2-mm slice thickness, pitch=1.5) with multiplanar reconstructions (MPR). Fractures were grouped according to a modified Munich classification scheme, differentiating six categories of fractures by joint involvement, number of fragments in the posterior facet, and the presence and extent of displacement. A qualitative and quantitative statement was made for the presence of clinical relevant displacement of the posterior articular facet (A:2 mm), widening of the heel (B: crossing fibular reference line), reduction in calcaneal height (C:10%), and axis shift of the calcaneocuboid angle (D:10 degrees ). Treatment recommendations resulting from the CT classification were retrospectively compared with the treatment given by examining the patients' files. There were 10 extra-articular and 38 intra-articular fractures; 8 were in class I (extra-articular, nondisplaced), 2 in class II (extra-articular, displaced), 1 in class III (intra-articular, nondisplaced), 20 in class IV (two fragments), 9 in class V (three fragments), and 8 in class VI (4 fragments), one of the latter being uncertain; 34 showed displacement of the articular facet, 35 widening of the heel, 35 reduction in calcaneal height, and 20 a shift of the axis. In 94% of the cases the procedure recommended by the Munich system of classification was followed; there was disagreement in 1 case in class I and 1 in class IV. Spiral CT allowed fracture classification and quantification of relevant displacement of fragments by radiologists. The implemented recommendations for treatment were adopted by surgeons in most cases.
Databáze: OpenAIRE
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