Classification of calcaneal fractures by spiral computed tomography: implications for surgical treatment.
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.
Linsenmaier
Ulrich
U
Department of Radiology, Klinikum der Universität München, Nussbaumstrasse 20, 80336 Munich, Germany. lin@ch-i.med.uni-muenchen.de
Brunner
Ulrich
U
Schöning
Alexander
A
Rieger
Johannes
J
Krötz
Michael
M
Mutschler
Wolf
W
Pfeifer
Klaus Jürgen
KJ
Reiser
Maximilian
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000000981:diagnostic imaging* / Q000293:injuries*; D002370:Casts, Surgical; D005260:Female; D018409:Foot Injuries / Q000000981:diagnostic imaging / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000379:methods; D017102:Fracture Healing / Q000502:physiology; D050723:Fractures, Bone / Q000145:classification* / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D036542:Tomography, Spiral Computed / Q000379:methods*; D016896:Treatment Outcome