Displaced Articular Calcaneus Fractures: Classification and Fracture Scores: A Preliminary Study
Thos Harnroongroj MD*, Bavornrit Chuckpaiwong MD*, Chayanin Angthong MD*, Pongtep Nanakorn MD*, Narumol Sudjai BSc*, Thossart Harnroongroj MD*
Affiliation : *Department of Orthopedics Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To review and group configurations of displaced articular calcaneal fracture advantaged for classification and
radiographic fracture scores.
Material and Method: Between 2002 and 2011, medical records and radiographs of patients who sustained acute displaced
articular calcaneal fractures were reviewed. The calcaneal fracture configurations were grouped as avulsion, bending, burst,
or combination. Radiographic displaced articular calcaneal fracture score was designed to include Bohler and Gissane
angles, degrees of posterior subtalar joint line parallel, degrees of varus, and burst. The calcaneal fracture score was
modified as power of the fracture response to treatment (PFRT). Prevalence of the fracture types, pre- and post-reduction
fracture scores including PFRT were studied and statistically analyzed.
Results : Sixty-four patients had 77 acute displaced articular calcaneal fractures. The classification consisted of type I
avulsion, type II compression bending, type III compression burst, type IV avulsion burst, and type V bending burst. Type IV
is the most common. The radiographic calcaneal fracture scores were 10 points. Pre-, post-reduction calcaneal fracture
scores and PFRT of type I, II, III, IV, and V were 4.17 (0.41), 0 and 1 (0), 4.63 (2.13), 0.50 (0.93) and 0.84 (0.35), 6.94 (2.05),
3.18 (1.38) and 0.50 (0.27), 8.03 (1.12), 3.03 (2.42) and 0.62 (0.30), and 7.22 (2.11), 3.00 (2.50) and 0.59 (0.29) respectively.
Statistical analysis showed significant difference (p < 0.05). PFRT for screw and pin fixation of type I plus II, IV, and V were
1.00 (0) and 1.00 (0), 0.64 (0.27) and 0.60 (0.36), and 0.54 (0.28) and 0.51 (0.45) respectively. PFRT for plate of type III was
0.54 (0.16). PFRT for casting of type I plus II, III, and IV were 0.50 (0.71), 0.27 (0.46), and 0.35 (0.33) respectively.
Conclusion : The classification consisted of five types, which were based on injury mechanisms as avulsion, bending, and
burst. The radiographic calcaneal fracture scores contained 10 points and were used for determining complexity of the
fractures. PFRT was used for evaluating efficacy of fracture treatment.
Keywords : Displaced articular, Calcaneal fracture configuration, Compression load, Avulsion, Bending, Burst, Parameters, Fracture scores, Power of fracture responses to treatments
