Correlation analysis of imaging parameters to evaluate the efficacy and prognosis of plate internal fixation in patients with calcaneal fracture

WANG Chun-xu; LIAN Hong-rui

doi:10.3969/j.issn.2095-252X.2026.02.002

Abstract：Objective To explore the correlation analysis of imaging parameters to evaluate the efficacy and prognosis of plate internal fixation in patients with calcaneal fracture.Methods A total of 196 patients with calcaneal fractures admitted to our hospital from January 2020 to January 2024 were retrospectively analyzed.They were categorized into a good prognosis group(n=156)and a poor prognosis group(n=40)based on the Maryland foot score(MFS)and were followed up for 12 months post-surgery.Repeated measures analysis of variance was used to analyze data that satisfied a normal distribution and homogeneous variance.A stratified regression model was used to analyze the relationship between calcaneal X-ray indicators and the Maryland score in different patients.A multivariate Cox regression model,adjusted for confounding variables,was employed to identify independent risk factors for prognosis in patients with calcaneal fractures.The Local Weighted Regression Scatter Smoothing Method(LOWESS)was utilized to analyze the two-dimensional curve relationship of continuous variables.The predictive efficacy of imaging parameters on the prognosis of patients with calcaneal fractures was evaluated using Receiver Operating Characteristic(ROC)curves.Results There were statistically significant differences between the two groups in terms of the length of hospital stay[good prognosis group:(7.35±2.67)d,poor prognosis group:(10.68±3.52)d,t=6.567,P<0.001],fracture healing time[good prognosis group:(80.15±9.37)d,poor prognosis group:(95.92±13.98)d,t=8.506,P<0.001],incisional infection[good prognosis group:5 cases(3.21%),poor prognosis group:7 cases(17.50%),χ2=11.319,P=0.001],joint stiffness[good prognosis group:7 cases(4.49%),poor prognosis group:11 cases(27.50%),χ2=20.216,P<0.001],total incidence of complications[good prognosis group:34 cases(21.79%),poor prognosis group:32 cases(80.00%),χ2=48.292,P<0.001],AOFAS score[good prognosis group:(88.71±14.78)points,poor prognosis group:(68.64±14.89)points,t=7.650,P<0.001],MFS score[good prognosis group:(87.61±7.59)points,poor prognosis group:(66.40±9.24)points,t=15.055,P<0.001],and VAS score[good prognosis group:(1.72±0.71)points,poor prognosis group:(3.01±1.67)points,t=7.416,P<0.001].There were statistically significant differences between the two groups in the Gissane angle[good prognosis group:(108.19±6.36)°,poor prognosis group:(85.77±5.33)°,t=20.514,P<0.001],Böhler angle[good prognosis group:(28.50±6.57)°,poor prognosis group:(18.46±4.54)°,t=9.114,P<0.001],Fowler angle[good prognosis group:(18.35±3.05)°,poor prognosis group:(11.76±3.97)°,t=11.420,P<0.001],calcaneal compression angle[good prognosis group:(30.57±4.82)°,poor prognosis group:(25.13±3.86)°,t=6.611,P<0.001],calcaneal height[good prognosis group:(46.67±1.11)mm,poor prognosis group:(40.24±1.02)mm,t=33.209,P<0.001],calcaneal width[good prognosis group:(37.37±1.99)mm,poor prognosis group:(41.22±2.06)mm,t=10.838,P<0.001],and calcaneal axis length[good prognosis group:(52.76±3.61)mm,poor prognosis group:(43.57±2.54)mm,t=15.154,P<0.001]at 6 months after surgery.There were also statistically significant differences between the two groups in the Gissane angle[good prognosis group:(122.25±8.93)°,poor prognosis group:(76.78±5.48)°,t=30.720,P<0.001],Böhler angle[good prognosis group:(40.12±7.07)°,poor prognosis group:(18.02±4.09)°,t=18.950,P<0.001],Fowler angle[good prognosis group:(39.45±3.65)°,poor prognosis group:(11.93±3.14)°,t=43.699,P<0.001],calcaneal compression angle[good prognosis group:(35.90±5.31)°,poor prognosis group:(29.92±5.37)°,t=6.340,P<0.001],calcaneal height[good prognosis group:(50.79±2.82)mm,poor prognosis group:(40.43±0.73)mm,t=22.997,P<0.001],calcaneal width[good prognosis group:(30.26±1.70)mm,poor prognosis group:(40.41±1.81)mm,t=33.245,P<0.001],and calcaneal axis length[good prognosis group:(57.59±4.17)mm,poor prognosis group:(48.49±2.24)mm,t=13.301,P<0.001]at 12 months after surgery.The intra-group comparison results showed that in the good prognosis group,there were statistically significant differences between the preoperative and 6-month postoperative values of the Gissane angle[preoperative:(96.31±6.37)°,6 months postoperatively:(108.19±6.36)°,t=16.484,P<0.001],Böhler angle[preoperative:(18.28±5.65)°,6 months postoperatively:(28.50±6.57)°,t=14.731,P<0.001],Fowler angle[preoperative:(11.62±2.51)°,6 months postoperatively:(18.35±3.05)°,t=21.280,P<0.001],calcaneal compression angle[preoperative:(20.01±2.32)°,6 months postoperatively:(30.57±4.82)°,t=24.656,P<0.001],calcaneal height[preoperative:(40.21±1.51)mm,6 months postoperatively:(46.67±1.11)mm,t=43.053,P<0.001],calcaneal width[preoperative:(43.94±2.01)mm,6 months postoperatively:(37.37±1.99)mm,t=29.012,P<0.001],and calcaneal axis length[preoperative:(38.79±2.57)mm,6 months postoperatively:(52.76±3.61)mm,t=39.375,P<0.001].Similarly,statistically significant differences were observed between the preoperative and 12-month postoperative values in the good prognosis group for the Gissane angle[preoperative:(96.31±6.37)°,12 months postoperatively:(122.25±8.93)°,t=29.537,P<0.001],Böhler angle[preoperative:(18.28±5.65)°,12 months postoperatively:(40.12±7.07)°,t=30.141,P<0.001],Fowler angle[preoperative:(11.62±2.51)°,12 months postoperatively:(39.45±3.65)°,t=78.469,P<0.001],calcaneal compression angle[preoperative:(20.01±2.32)°,12 months postoperatively:(35.90±5.31)°,t=34.250,P<0.001],calcaneal height[preoperative:(40.21±1.51)mm,12 months postoperatively:(50.79±2.82)mm,t=41.310,P<0.001],calcaneal width[preoperative:(43.94±2.01)mm,12 months postoperatively:(30.26±1.70)mm,t=64.905,P<0.001],and calcaneal axis length[preoperative:(38.79±2.57)mm,12 months postoperatively:(57.59±4.17)mm,t=47.937,P<0.001].In the poor prognosis group,statistically significant differences were found between the preoperative and 6-month postoperative values of the Gissane angle[preoperative:(96.35±6.34)°,6 months postoperatively:(85.77±5.33)°,t=8.079,P<0.001],calcaneal compression angle[preoperative:(19.99±2.25)°,6 months postoperatively:(25.13±3.86)°,t=7.276,P<0.001],calcaneal width[preoperative:(43.88±2.07)mm,6 months postoperatively:(41.22±2.06)mm,t=5.761,P<0.001],and calcaneal axis length[preoperative:(38.80±2.55)mm,6 months postoperatively:(43.57±2.54)mm,t=8.382,P<0.001].Additionally,statistically significant differences were noted between the preoperative and 12-month postoperative values in the poor prognosis group for the Gissane angle[preoperative:(96.35±6.34)°,12 months postoperatively:(76.78±5.48)°,t=14.770,P<0.001],calcaneal compression angle[preoperative:(19.99±2.25)°,12 months postoperatively:(29.92±5.37)°,t=10.787,P<0.001],calcaneal width[preoperative:(43.88±2.07)mm,12 months postoperatively:(40.41±1.81)mm,t=7.981,P<0.001],and calcaneal axis length[preoperative:(38.80±2.55)mm,12 months postoperatively:(48.49±2.24)mm,t=18.056,P<0.001].The influence of time factors on Gissane angle,Böhler angle,Fuller angle,calcaneal height,calcaneal width,and calcaneal axis length varied with different prognosis(Finteraction=86.013,101.223,56.732,101.205,81.182,84.358,all P<0.001).The results of multiple logistic regression analysis showed that Gissane angle,Böhler angle,Fowler angle,calcaneal compression angle,calcaneal height,and increased calcaneal axis length were independent protective factors affecting the prognosis of patients with calcaneal fractures,while increased calcaneal width was an independent risk factor affecting the prognosis of patients with calcaneal fractures(all P<0.05).LOWESS analysis found that there was a certain non-linear relationship between the incidence of poor prognosis in patients with calcaneal fractures and Gissane angle,Böhler angle,Fowler angle,calcaneal compression angle,calcaneal height,calcaneal width,and calcaneal axis length.There was no significant non-linear relationship between the incidence of poor prognosis in patients with calcaneal fractures and the posterior articular inclination angle.The imaging parameters of Gissane angle,Böhler angle,Fowler angle,calcaneal compression angle,calcaneal height,calcaneal width,and calcaneal axis length had good predictive efficacy for the prognosis of patients with calcaneal fractures.And the combination of calcaneal X-ray indicators predicted the prognosis of calcaneal fractures,with the best predictive performance.Conclusions Gissane angle,Böhler angle,Fowler angle,calcaneal compression angle,calcaneal height,and increased calcaneal axis length are independent protective factors affecting the prognosis of patients with calcaneal fractures,while increased calcaneal width is an independent risk factor affecting the prognosis of patients with calcaneal fractures.The combined prediction of calcaneal X-ray indicators for the prognosis of calcaneal fractures has good predictive efficacy.