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Primary arthrodesis versus open reduction and internal fixation following intra-articular calcaneal fractures: a weight-bearing CT analysis

  • Trauma Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Purpose

To compare primary arthrodesis (PA) versus open reduction and internal fixation (ORIF) in displaced intra-articular calcaneal fractures (DIACFs), based on clinical outcome and 2D and 3D geometrical analyses obtained from weight-bearing (WB) cone-beam CT images.

Materials and methods

In this prospective study, 40 patients with surgically treated calcaneal fractures were included, consisting of 20 PA and 20 ORIF patients. Weight-bearing cone-beam CT-images of the left and right hindfoot and forefoot were acquired on a Planmed Verity cone-beam CT-scanner after a minimum of 1-year follow-up. Automated 2D and 3D geometric analyses, i.e., (minimal and average) talo-navicular joint space, calcaneal pitch (CP), and Meary’s angle (MA), were obtained for injured and healthy feet. Clinical outcomes were measured using the EQ5D and FFI questionnaires.

Results

Overall, there were no differences in baseline patient characteristics apart from age (p < 0.005). The calcaneal pitch in 2D after treatment by ORIF (13.8° ± 5.6) was closer to the uninjured side (18.1° ± 5.5) compared to PA (10.9° ± 4.5) (p < 0.001). Meary’s angle in 2D was closer to the uninjured side (8.7° ± 6.3) after surgery in the PA cohort (7.0° ± 5.8) compared to the ORIF cohort (15.5° ± 5.9) (p = 0.046). In 3D measurements, CP was significantly decreased for both cohorts after surgery (– 4.09° ± 6.2) (p = 0.001). MA was not significantly affected overall or between cohorts in 3D. Clinical outcomes were not significantly different between the ORIF and PA cohorts. None of the radiographic measurements in 2D or 3D correlated with any of the clinical outcomes studied.

Conclusion

Three-dimensional WB CT imaging enables functional 2D and 3D analyses under natural load in patients with complex calcaneal fractures. Based on clinical outcome, both PA and ORIF appear viable treatment options. Clinical correlation with geometrical outcomes remains to be established.

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Data availability

The data that support the findings of this study are available from the corresponding author, T.S., upon reasonable request.

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Acknowledgements

This research was supported by the Amsterdam Movement Sciences (AMS) research institute.

Funding

This study was not supported by any funding.

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Authors and Affiliations

  1. Department of Trauma Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands

    N. S. V. L. Baboeram, F. R. K. Sanders & T. Schepers

  2. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands

    R. H. H. Wellenberg, G. J. Streekstra & M. Maas

  3. Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, Location AMC, Amsterdam, The Netherlands

    J. G. G. Dobbe & G. J. Streekstra

  4. Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands

    N. S. V. L. Baboeram, F. R. K. Sanders, R. H. H. Wellenberg, J. G. G. Dobbe, G. J. Streekstra, M. Maas & T. Schepers

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  1. N. S. V. L. Baboeram
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  3. R. H. H. Wellenberg
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  4. J. G. G. Dobbe
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Correspondence to N. S. V. L. Baboeram.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. METC2019_038.

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Baboeram, N.S.V.L., Sanders, F.R.K., Wellenberg, R.H.H. et al. Primary arthrodesis versus open reduction and internal fixation following intra-articular calcaneal fractures: a weight-bearing CT analysis. Arch Orthop Trauma Surg 144, 755–762 (2024). https://doi.org/10.1007/s00402-023-05120-5

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