الفهرس 
Anatomy of the calcaneus
Plain radiographs :Only 14 pages are availabe for public view
 |  | from | 138 |  |  |
| | | from | 138 | | |
Abstract
The calcaneus is the most frequently fractured tarsal bone. Calcaneus fractures account for 60% of all tarsal fractures. The aim of this study is to explore the anatomy and patho-physiology of calcaneal fractures, with emphasis on their appearances at CT, and discuss the impact of these CT findings on the management of these fractures. This study included 50 patients,46 unilateral, (4 bilateral injuries); 80% males and 20% female suffering from unilateral & bilateral foot injuries as regarding trauma, Multi detector CT of calcaneus was done for all cases after conventional radiography. Multi-detector CT allows better visualization of fracture lines, dislocation & comminution of calcaneal fractures, specially intra-articular fractures. Involvement of the posterior facet of the subtalar joint is used to clarify fracture type according to the Sanders classification system for intra articular fractures, which represent most of of calcaneal fractures. Sanders system has proved useful, having been shown to correlate with management and prognosis, without significant interobserver variability. Extra articular fractures include all fractures that don’t involve posterior facet & they are classified according to the basis of their anatomic location on the anterior process, body, & posterior tuberosity of the calcaneus. In our study we found 7.4 % patient extra articular and 92.6% patient intra articular fractures, According Sanders classification intra articular fracture were; type I 10%, type II 6%, type III 36% and 48% type IV. Bohler’s angle considered as an important parameter in the assessment and diagnosis of the Calcaneal fracture, It normally measures between 25o and 40o degrees, if an angle of Bohler less than 20° indicates posterior facet collapse from an underlying calcaneal fracture. So we found that there was no statistically significant correlation found between Sander type I (p value = 0.051), type II (p value = 0.655) and type III (p value = 0.898) and Bohler’s angle, but there was significant correlation concerning type IV (p value = 0.013). Fracture of the calcaneus occasionally extends anteriorly to the calcaneocuboid joint, CT images allowed to assess degree of calcaneo-cuboid joint involvement before surgery, these study was revealed that 68.5 % cases involved calcaneo-cuboid joint, all cases were intra articular fracture, Sanders classification permits to predict pattern of involvement of calcaneo-cuboid joint (p value = 0.031). According to suitable planes for Sander’s classification of intra articular calcaneal fractures we found that the coronal reconstructed images were the most sensitive, specific and accurate with sensitivity of 95%, specificity of 80% and accuracy of 90% while the axil planes were found to be the least of all by sensitivity of 75%, specificity of 66% and 70% accuracy. As regarding complication , The diagnosis of the associated soft tissue injuries was found more accurate when used the axial images than the other planes by sensitivity of 97%, specificity of 95% and accuracy of 97%. All patient were subjected to follow up for the management after CT scan, we found that 32 patients were managed conservatively and 22 patients were managed surgically, 18 patients were managed by closed reduction and external or percutaneous fixation , and 4 patients were managed by open reduction internal fixation. Prognosis of patient with extra-articular fractures better than those with intra-articular fractures.