3D mapping of intra-articular calcaneal fractures

To determine the pattern of intra-articular calcaneal fractures (ICFs) by a three-dimensional (3D) mapping and determine whether there were consistent fracture patterns and comminution zones. In this study, 67 patients with ICFS by CT scan were included. The calcaneal fractures fragments in CT were multiplanar reconstructed and virtual reduced. 3D heat mapping was subsequently created by graphically superimposing all fracture lines onto a standard calcaneal template. The cohort included 26 (38.8%) left calcaneal fractures, 27 (40.30%) right calcaneal fractures, and 14 (20.9%) cases with bilateral fractures. Comminuted fractures accounted for 92.5%. Sagittal 3D mapping shows that the fracture line is mainly concentrated at the critical angle of Gissane and extending rear to the posterior of the tuberosity of the lateral wall and the anterior of the medial process of the calcaneus tuberosity but with more significant variation in the medial wall. The average angle of fracture lines concerning the long calcaneal axis (LCA) was 29.1 degrees and 19.2 degrees in the lateral and medial walls. Axial 3D mapping shows that fracture lines were primarily concentrated in the anterior area to the posterior joint facet and extending along the rear joint facet and calcaneus sulcus to the posteriorly of the tuberosity. The mean angle of fracture lines concerning the LAC was 11 degrees in the axial wall. Our data provided elucidated that ICFs have consistent characteristic fracture patterns and comminution zones. This study provides visual guidelines for understanding fracture morphology, which may assist with fracture classification, preoperative planning, development of fixation concepts.

Automated summary

This study aimed to determine the pattern of intra-articular calcaneal fractures (ICFs) using three-dimensional mapping and investigate consistent fracture patterns and comminution zones. CT scans of 67 patients with ICFS were analyzed, and multiplanar reconstruction and virtual reduction were performed on the calcaneal fracture fragments. Three-dimensional heat mapping was created by superimposing fracture lines onto a standard calcaneal template. The study found that ICFs have consistent characteristic fracture patterns and comminution zones.