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Morphological analysis of Gissane’s angle utilising a statistical shape model of the calcaneus

  • Trauma Surgery
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Abstract

Introduction

Gissane’s crucial angle (GA) facilitates to diagnose calcaneal fractures, and serves as an indicator of the quality of anatomical reduction after fixation. The study aimed to utilise statistical shape models (SSM) for analysing the complex 3D surface anatomy of the calcaneus represented by the simplified GA measurement on lateral radiographs.

Materials and methods

SSMs were generated from CT scans of paired adult calcanei from 10 Japanese and 31 Thai specimens. GA measurements in 3D and 2D were obtained for the lateral, central and medial anatomy of the posterior facet and sinus tarsi. The correlation between calcaneal length and GA was analysed. Regression and principal component (PC) analyses were conducted for analysing morphological variability in calcaneal shape relating to GA. The bilateral symmetry of the obtained measurements was analysed.

Results

The mean GA (lateral) for the Japanese specimens was 105.1° ± 7.5 and 105.4° ± 8.5 for the Thai. The projected 2D angles of the central and medial measurements were larger (P < 0.00) than the 3D values. The medial projected 2D angles were larger (P ≤ 0.02) compared to the lateral. Despite the bilateral symmetry of GA and calcaneal length, their correlation displayed clear signs of asymmetry, which was confirmed by regression and PC analyses.

Conclusions

Japanese and Thai specimens revealed lower GAs (both range and mean) compared to reported reference values of other ethnicities. As a reduced GA is generally indicative of a calcaneal fracture, our results are important to surgeons for their diagnostic assessment of Japanese and Thai patients. The results indicate that the GA measurement on a plain radiograph is a simplified representation of the lateral-to-central 3D calcaneal anatomy but significantly underestimates the angle measurement on the medial aspects of the respective surface areas.

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Acknowledgements

The study was supported in part through a Scientific Exchanges Grant (IZSEZO_186525) from the Swiss National Science Foundation.

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Authors and Affiliations

  1. Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, QLD, 4059, Australia

    Beat Schmutz & Yohan Kai Schmutz-Leong

  2. Jamieson Trauma Institute, Metro North Hospital and Health Service, Herston, QLD, 4029, Australia

    Beat Schmutz

  3. Department of Mathematics and Computer Science, University of Basel, Spiegelstrasse 1, 4051, Basel, Switzerland

    Marcel Lüthi

  4. Queensland X-Ray, Mater Hospital Brisbane, 301 Vulture St, South Brisbane, QLD, 4101, Australia

    Ryan Shulman

  5. Department of Orthopaedic Surgery, Gold Coast University Hospital, 1 Hospital Boulevard, Southport, QLD, 4215, Australia

    Simon Platt

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  1. Beat Schmutz
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  2. Marcel Lüthi
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  3. Yohan Kai Schmutz-Leong
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  4. Ryan Shulman
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Correspondence to Beat Schmutz.

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The authors declare that they have no competing interests.

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The CT data utilised were available from studies previously published.

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Schmutz, B., Lüthi, M., Schmutz-Leong, Y.K. et al. Morphological analysis of Gissane’s angle utilising a statistical shape model of the calcaneus. Arch Orthop Trauma Surg 141, 937–945 (2021). https://doi.org/10.1007/s00402-020-03566-5

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  • DOI: https://doi.org/10.1007/s00402-020-03566-5

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