The effect of treatment protocol on calcaneus bone mineral densitometry after intra-articular calcaneal fractures

Year 2016, Volume: 2 Issue: 2, 116 - 120, 04.07.2016

Faruk Mehmet Catma , Serhan Unlu , Ubeydullah Sevgili Alper Ozturk , Sinan Yuksel Murat Altay

https://doi.org/10.18621/eurj.2016.5000139764

Abstract

Objective. To identify the effect of treatment protocol on calcaneus bone mineral density of calceneal fractures treated with different methods. Methods. Sixty-three patients with intra-articular calcaneal fractures were observed prospectively. Patients were classified according to their treatment protocols such as; conservative treatment with short leg plaster cast (Group C), closed reduction and fixation with cannulated screws (Group S) and open reduction internal fixation with plate and screws (Group P). All patients’ bilateral radiographies, CT scans, the American Orthopaedic Foot and Ankle Society (AOFAS) scores and calcaneus bone mineral density measurements by G&E Archilles Quantitative Ultrasound method were obtained at 15^th month of follow up period. Results. Fourteen (22%) patients were female and 49 (88%) were male. The mean age was 43.7±12.1 years. The mean follow-up was 33.7±14.7 months. Bone mineral density measurements were calculated as; t scores;  -1.48±1.24 for group C, -1.48±1.31 for group S, -0.27±1.68 for group P and z scores; -0.18±1.41 for group C, -0.17±1.9 for group S,  0.96 ± 1.54 for group P. Group P had the higher t and z scores of injured sides than other groups (p=0.008 and p=0.026, respectively). Average AOFAS scores were 78.13±13.04 in group S, 82.58±10.81 in group P and 79.82±11.75 in group C. No significant differences were detected between groups regarding AOFAS scores. Conclusion. Measurement of calcaneus bone mineral density which we used in our study is a method for evaluation of calcaneal fracture treatments and higher density values were found in open reduction and internal fixation group. This may be owing to better control of defect with the allograft and early mobilization by the evident improvement in angular correction.

 

Keywords

treatment protocol, Calcaneal fracture, quantitative ultrasound method, bone mineral density, American Orthopaedic Foot and Ankle Society (AOFAS) scores, plaster

References

• Zwipp H, Rammelt S, Barthel S. [Calcaneal fractures—the most frequent tarsal fractures]. Ther Umsch 2004;61:435-50. [Article in German]
• Rammelt S, Zwipp H. Calcaneal fractures: facts, controversies and recent developments. Injury 2004;35:443-61.
• Howard JL, Buckley R, McCormack R, Pate G, Leighton R, Petrie D, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma 2003;17:241-9.
• Ibrahim T, Rowsell M, Rennie W, Brown AR, Taylor GJ, Gregg PJ. Displaced intra-articular calcaneal fractures: 15 year follow-up of a randomised controlled trial of conservative versus operative treatment. Injury 2007;38:848-55.
• Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, et al. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet 1993;341:72-5.
• Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ 1996;312:1254-9.
• Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD. Low bone mineral density and fracture burden in postmenopausal women. CMAJ 2007;177:575-80.
• Kanis JA, Oden A, Johnell O, Johansson H, De Laet C, Brown J, et al. The use of clinical risk factors enhances the performance of BMD in the prediction of hip and osteoporotic fractures in men and women. Osteoporos Int 2007;18:1033-46.
• Kitaoka HB, Alexander IJ, Adelaar RS, Nunley JA, Myerson MS, Sanders M. Clinical rating systems fort he ankle-hindfoot, midfoot, hallux, and lesser toes. Foot Ankle Int 1994;15:349-53.
• Bozkurt M, Kentel BB, Yavuzer G, Ocguder A, Heycan C, Tonuk E. Functional evaluation of intraarticular severely comminuted fractures of the calcaneus with gait analysis. J Foot Ankle Surg 2004;43:374-9.
• Eastwood DM, Langkamer VG, Atkins RM. Intra-articular fracture of the calcaneum.Part II.Open reduction and internal fixation by the extend transcalcaneal approach. J Bone Joint Surg Br 1993;75:189-95.
• Paley D, Hall H. Intra-articular fractures of the calcaneus. Acritical analysis of results and prognostic factors. J Bone Joint Surg Am 1993;75:342-54.
• Sanders R, Gregory P. Operative treatment of intra-articular fractures of the calcaneus. Orthop Clin North Am 1995;26:203-14.
• Myerson MS. Primary subtalar arthrodesis for the treatment of comminuted fractures of the calcaneus. Orthop Clin North Am 1995;26:215-27.
• Griffin D, Parsons N, Shaw E, Kulikov Y, Hutchinson C, Thorogood M, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ 2014;24;349:g4483.
• Basile A. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures. J Foot Ankle Surg 2010;49:25-32.