0
Scientific Articles   |    
Displacement of the Sustentacular Fragment in Intra-Articular Calcaneal Fractures
Wayne Berberian, MD1; Amit Sood, MD1; Briette Karanfilian1; Robert Najarian, MD1; Sheldon Lin, MD1; Frank Liporace, MD1
1 Department of Orthopaedic Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, 90 Bergen Street, Suite 7300, Newark, NJ 07103. E-mail address for A. Sood: soodam@umdnj.edu
View Disclosures and Other Information
  • Disclosure statement for author(s): PDF

Investigation performed at the Department of Orthopaedic Surgery, University of Medicine and Dentistry of New Jersey, New Jersey Medical School, Newark, New Jersey



Disclosure: One or more of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of an aspect of this work. In addition, one or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jun 05;95(11):995-1000. doi: 10.2106/JBJS.L.01498
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Background: 

The sustentacular fragment in displaced intra-articular calcaneal fractures has historically been portrayed as a “constant fragment,” bound to the talus by the interosseous and deltoid ligament complex. Operative treatment typically occurs through a lateral approach, with the remaining calcaneus being reconstructed back to the sustentaculum. We hypothesized that the sustentacular fragment in displaced intra-articular calcaneal fractures does not maintain its relationship to the talus. The purpose of this study was to characterize the frequency, magnitude, and mode of displacement of the sustentacular fragment.

Methods: 

Computed tomographic (CT) scans of eighty-eight patients with 100 displaced intra-articular calcaneal fractures admitted to our level-I trauma center over a five-year period were retrospectively reviewed. Basic patient demographics and mechanisms of injury were recorded. CT scans were graded according to the Sanders classification, and associated injuries were noted. Angulation and translation of the sustentacular fragment as well as gapping and intra-articular fractures of the middle facet were examined. Angulation exceeding 10° and translation of more than 3 mm were considered diagnostic of displacement.

Results: 

Overall, the sustentacular fragment was displaced in forty-two of the 100 fractures. Twenty-five of one hundred calcanei had sustentacular fragment angulation of >10°, twenty-four had sustentacular translation >3 mm, twenty had fracture diastasis of the middle facet, and twenty-one had a displaced intra-articular fracture of the calcaneal middle facet. Fractures involving greater than 50% of the posterior facet (consistent with Sanders Type-B and Type-C fracture lines) demonstrated a significant increase in relative risk of angulation and translation of the sustentacular fragment as well as gapping and intra-articular fractures of the middle facet. Three-part or four-part fractures also showed a significant association with overall displacement of the sustentaculum.

Conclusions: 

This study is the first to our knowledge to quantify in a detailed manner the displacement of the sustentacular fragment as occurring with calcaneal fractures. This displacement disproves the “constant” theory of the sustentacular fragment, and it may alter the quality of the fracture reduction and affect patient outcome. An alternative surgical approach may be indicated for the treatment of certain calcaneal fracture patterns with sustentacular displacement.

Level of Evidence: 

Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Figures in this Article
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    12/31/2013
    S. Carolina - Department of Orthopaedic Surgery Medical Univerity of South Carlonina
    12/04/2013
    New York - Icahn School of Medicine at Mount Sinai
    04/16/2014
    Connecticut - Yale University School of Medicine