SLR - October 2010 - R Abram Swensen
Reference: Kinner, Bernard; Schieder, Sarah; Miller, Franz; Pannek, Anja; Roll, Christina (2010). Calcaneocuboid Joint Involvement in Calcaneal Fractures. Journal of Trauma, 68(5):1192-1199.
Scientific Literature Review
Reviewed By: R Abram Swensen
Residency Program: OCPM and University Hospital Richmond Heights MC
Podiatric Relevance:
Reports on the incidence of calcaneocuboid joint (CCJ) involvement in calcaneal fractures are scarce, and they also vary considerably. Normal gait relies on the kinematics of the subtalar joint and the relationship between the talocalcaneal and calcaneocuboid articulations. This article demonstrates that calcaneal fractures with CCJ involvement are associated with more severe injury and trauma, making it relevant to address during surgery.
Methods:
The records of 106 patients treated by the authors between 2000 and 2004 with acute calcaneal fractures were reviewed for fracture classification, mechanism of injury, surgical treatment and complications. Radiographs and CT scans were utilized to access the involvement of the CCJ. Forty-four of the total 106 patients (33 men and 11 women) with a mean age of 45.5 years met the inclusion criteria. Outcome measures included SF-36 scores, AOFAS scores, radiographic evaluation, a patient-based questionnaire and gait analysis.
Results:
The prevalence of CCJ involvement was 68%. Fractures involving the CCJ were caused by a more severe injury than fractures without CCJ involvement. There was also a strong correlation between CCJ involvement and the injury classification (as per the Sanders classification). CCJ involvement was also associated with long-term difficulty walking on rough surfaces and gait limitations confirmed by dynamic pedography. The development of post traumatic osteoarthritis was associated with the fracture classification and the quality of reduction.
Conclusion:
This study specifically analyzes the involvement of the CCJ and fracture severity with functional outcomes. CCJ involvement is seen in fractures associated with more severe trauma and these injuries carry worse patient outcomes. This indicates that the CCJ in these types of injuries should be addressed during surgery. More resources should go towards gaining a better understanding of CCJ involvement and its correlation with severity of injury. This study claims to be the first to draw these comparisons and further studies involving greater numbers of patients and more clearly defined variables would be important. More studies are needed in order to address the many variables involved in the outcome of patient recovery, and the future development of conditions such as osteoarthritis.