Purpose

Fractures of the calcaneus are reported most commonly in the tarsal region. Their incidence is highest among active people in productive age. As such, optimal treatment can have vast implications for patients. The study aimed to compare calcaneal proportions of the Czech population in the last centuries to present day, for a precise choice and positioning of the osteosynthetic material, and its safe implantation in the anterior part of the calcaneus. Furthermore, we describe the frequency of the calcaneocuboid joint involvement in calcaneal fractures.

Methods

We obtained 69 macerated (dry) human calcanei from anatomical collections along with multiplanar reconstructions obtained from 43 serial CT scans from patients with injuries other than calcaneal fractures. Specimens were measured using a modified set of Bidmos et al. criteria (2006). Two groups (CT scans of macerated specimens and patients’ CT scans) were statistically evaluated and compared with the help of an experienced statistician. Furthermore, scans of 80 surgically treated patients were retrospectively assessed for calcaneocuboid joint involvement.

Results

The median tilt of the calcaneocuboid joint in the transverse plane was 67° in the anatomical specimens and 72° in the multiplanar reconstructed CT scans taken from patients with intact tarsal regions. These results suggest that the length of screws should be ideally in the range between 21.3 and 25 mm. In 47.3% of the patients presenting with a fractured calcaneus, the calcaneocuboid joint was involved. There was a statistically significant difference in most of the variables observed between the two groups.

Conclusion

As the calcaneocuboid joint involvement appears to be present in up to 50% of cases, adequate care should be taken. To maximize the biomechanical properties of the construct and to minimize the risks, our findings suggest the screws should be at an inner tilt of 68–74° from the lateral calcaneal wall and be of 23.5–26.2 mm length. However, due to differences between the two groups and the small sample size, further investigation is needed.

中文翻译：

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人体跟骨的人体测量法和长方体关节面的方向，作为在骨折治疗中解剖学上正确定位骨合成螺钉的基础。

目的

跟骨骨折最常见于睑板区域。在活跃年龄的活跃人群中，他们的发病率最高。因此，最佳治疗可能会对患者产生巨大影响。这项研究的目的是比较过去几个世纪至今的捷克人口跟骨比例，以精确选择和定位骨合成材料，并将其安全植入跟骨前部。此外，我们描述了跟骨骨折累及跟骨关节的频率。

方法

我们从解剖学集合中获得了69个浸软的（干的）人钙质，以及从43处跟骨骨折以外的患者的43次连续CT扫描中获得了多平面重建。标本使用一组改良的Bidmos等进行测量。标准（2006）。对两组（浸软标本的CT扫描和患者的CT扫描）进行统计学评估，并在经验丰富的统计学家的帮助下进行比较。此外，对80例接受手术治疗的患者的扫描进行了回顾性评估，以了解跟骨跟关节的参与情况。

结果

解剖标本中跟骨关节横断面的中位倾斜度在解剖标本中为67°，而在多平面重建CT扫描中取自完整骨区域的患者为72°。这些结果表明，螺钉的长度理想地应在21.3到25 mm之间。在跟骨骨折的患者中，有47.3％的对象是跟骨跟骨关节。两组之间观察到的大多数变量在统计学上都有显着差异。

结论

由于跟骨跟骨关节受累的情况似乎高达50％，因此应采取足够的措施。为了最大程度地提高结构的生物力学性能并最大程度地降低风险，我们的研究结果表明，螺钉应与跟骨外侧侧壁的内倾角为68–74°，长度应为23.5–26.2 mm。但是，由于两组之间的差异以及样本量较小，因此需要进一步调查。