Correlation of 3D Joint Space Width From Weightbearing CT With Outcomes After Intra-articular Calcaneal Fracture

Abstract

Background: Posttraumatic osteoarthritis (PTOA) of the subtalar joint is a serious, disabling, and frequent complication following intra-articular calcaneal fractures (IACFs). Using plain radiographs to assess the subtalar joint for PTOA is imprecise and insensitive, hindering progress toward improving treatment and assessing outcomes. This study explored how low-dose weightbearing computed tomography (WBCT) can be used to provide reliable, quantitative 3D measures of subtalar joint space width (JSW) following IACF and correlated the 3D JSW with clinical outcomes. Methods: After institutional review board approval, 21 patients (15 male; age, 28-70 years) who sustained IACFs and were treated with percutaneous surgical reduction underwent WBCT scans at follow-up visits 2 to 15 years (average, 7.8 years) after surgical treatment. Subtalar joint 3D JSW was computed after a semiautomated protocol was used to segment the talus and calcaneus from the WBCT data. Mean and minimum 3D JSW measurements were calculated and compared with Kellgren-Lawrence (KL) radiographic osteoarthritis grade, RAND-36 Physical (PCS) and Mental (MCS) Component Scores, and visual analog scale (VAS) pain scores. Spearman’s rank correlation was used to detect the strength of association between variables, with significance set at P