Does the Addition of Computed Tomography to Computed Radiography Provide More Value to Final Outcomes and Treatment Decisions in Displaced Intra-Articular Calcaneal Fractures?
Chayanin Angthong MD*, Akekapong Atikomchaiwong MD*, Ichiro Yoshimura MD, PhD**, Kazuki Kanazawa MD**, Thos Harnroongroj MD***, Wirana Angthong MD****, Tomonobu Hagio MD**, Akinori Takeyama MD, PhD**, Masatoshi Naito MD, PhD**
Affiliation : * Department of Orthopaedics, Faculty of Medicine, Thammasat University, Pathumthani, Thailand ** Department of Orthopaedic Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan *** Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand **** Department of Radiology, Thammasat University Hospital, Pathumthani, Thailand
Background : Little is known about the additional prognostic value of computed tomography (CT) in addition to computed
radiography in displaced intra-articular calcaneal fractures. The present study was undertaken to examine and compare the
final radiographic outcomes and the prevalence of treatment methods of displaced intra-articular calcaneal fractures in
patients with preoperative computed radiography alone vs. a combination of computed radiography and computed tomogra-
phy.
Material and Method: Thirty-four patients with 38 displaced intra-articular calcaneal fractures were divided into two
groups: a group that was evaluated with computed tomography and computed radiography (17 patients; 20 fractures) and
a group that was evaluated with computed radiography alone (17 patients; 18 fractures). Patient demographics, pre-
operative and postoperative Bohler’s angles, and fracture classifications were recorded. Postoperative outcomes were
evaluated using calcaneal fracture radiographic scores (modified Zwipp score).
Results : The mean age of our patients in the present study was 43.3+12.3 years. The mean age of the patients in the computed
tomography group (48.4+11.6 years) was significantly higher than that of the non-computed tomography group (37.6+10.7
years, p = 0.005). The mean follow-up time was 17.4+9.8 months. There was a significantly higher prevalence of open
reduction and internal fixation in the computed tomography group versus the non-computed tomography group (p = 0.019).
However, there was no significant difference observed for the mean radiographic scores. Postoperatively, outcomes were
satisfactory in both groups, although intra-articular alignment was significantly better in the computed tomography group (p
= 0.020).
Conclusion : The overall outcomes were comparable between the patient groups with computed tomography vs. those
without computed tomography, except for the superiority of postoperative intra-articular alignment in patients with computed
tomography. Open reduction and internal fixation were more frequently performed in the patients with computed tomography
than patients without computed tomography.
Keywords : Calcaneus, Fracture, Computed tomography
