Talar-sided osteochondral lesion of the subtalar joint following the intra-articular calcaneal fracture: study via a modified computed tomography mapping analysis

  • Chayanin AngthongEmail author
  • Andrea Veljkovic
  • Wirana Angthong
  • Prasit Rajbhandari
Original Article • FOOT - FRACTURES



This study is to report the prevalence of osteochondral lesions in subtalar joint following intra-articular calcaneal fracture, including the relationship between fracture severity and lesion characteristics, using modified computed tomography (CT) mapping analysis.


Thirty patients with intra-articular calcaneal fracture who were preoperatively imaged with modified CT mapping analysis were recruited. The presence of talar-sided osteochondral lesions (OLTS) of subtalar joint was noted with lesion area defined by Akiyama’s mapping classification. Lesion severity was assessed via Ferkel’s classification, and fracture severity via Sanders’ classification.


Lesions were found in 28 patients (93.3%), mostly at anterior [16 (57.1%) lesions] or central [13 (46.4%) lesions] areas of posterior talar facet. Most common grade of lesion severity was grade I (mild) seen in 24 (80%) patients. Most fractures were classified as Sanders’ grade III and IV with 12 (40%) and 12 (40%) patients noted, respectively. High severity of fracture denoted by Sanders’ grade IV showed a trend of higher prevalence of OLTS at anterior and central sites of posterior talar facet (P = 0.181). Lesion severity was significantly higher in patients with double lesions than patients with single lesions (P = 0.005). However, OLTS were not significantly related with osteoarthritic changes in follow-up radiographs (P > 0.05).


The prevalence of OLTS is very high following intra-articular calcaneal fractures. Most lesions occur at anterior or central area of posterior talar facet and are more likely to occur in patients with higher fracture severity. Lesion severity was significantly higher in patients with double lesions than patients with single lesions.


Calcaneus Fracture Osteochondral Talus Arthritis Computed tomography 



The author would like to propose special thanks to Drs. Suebsakul Nangnual, Saowabhak Nitayavardhana, and Rakop Taveesuksiri (research assistants) for their helps in the present study.

Compliance with ethical standards

Conflict of interest

Dr. Angthong reports personal fees from Menarini, personal fees from Amgen, personal fees from Smith & Nephew, outside the submitted work; Dr. Veljkovic reports grants from Wright medical, grants from Zimmer, grants from Acumed, grants from Ferring, grants from Synthes, grants from Arthrex, outside the submitted work; Dr. Angthong has nothing to disclose; Dr. Rajbhandari has nothing to disclose.


  1. 1.
    Harnroongroj T, Chuckpaiwong B, Angthong C, Nanakorn P, Sudjai N, Harnroongroj T (2012) Displaced articular calcaneus fractures: classification and fracture scores: a preliminary study. J Med Assoc Thai 95(3):366–377Google Scholar
  2. 2.
    Lim EV, Leung JP (2001) Complications of intraarticular calcaneal fractures. Clin Orthop Relat Res 391:7e16CrossRefGoogle Scholar
  3. 3.
    Long C, Fang Y, Huang FG et al (2016) Sanders II-III calcaneal fractures fixed with locking plate in elderly patients. Chin J Traumatol 19:164–167. CrossRefGoogle Scholar
  4. 4.
    Ball ST, Jadin K, Allen RT et al (2007) Chondrocyte viability after intra-articular calcaneal fractures in humans. Foot and Ankle Int 28:665–668CrossRefGoogle Scholar
  5. 5.
    Rothberg DL, Yoo BJ (2014) Posterior facet cartilage injury in operatively treated intra-articular calcaneus fractures. Foot Ankle Int 35:970–974. CrossRefGoogle Scholar
  6. 6.
    Ferkel RD, Sgaglione NA, Del Pizzo W (1990) Arthroscopic treatment of osteochondral lesions of the talus: techinque and results. Orthop Trans 14:172–173Google Scholar
  7. 7.
    de Lima E, de Queiroz F, Lopes OV Jr, Spinelli Lde F (2011) Treatment of osteochondral lesions of the talus by means of the arthroscopy-assisted microperforation technique. Rev Bras Ortop 46:702–708. CrossRefGoogle Scholar
  8. 8.
    Akiyama K, Sakai T, Sugimoto N, Yoshikawa H, Sugamoto K (2012) Three-dimensional distribution of articular cartilage thickness in the elderly talus and calcaneus analyzing the subchondral bone plate density. Osteoarthr Cartil 20:296–304. CrossRefGoogle Scholar
  9. 9.
    Utukuri MM, Knowles D, Smith KL, Barrie JL, Gavan D (2000) The value of the axial view in assessing calcaneal fractures. Injury 31:325–326CrossRefGoogle Scholar
  10. 10.
    Angthong C, Atikomchaiwong A, Yoshimura I et al (2014) Does the addition of computed tomography to computed radiography provide more value to final outcomes and treatment decisions in displaced intra-articular calcaneal fractures? J Med Assoc Thai 97(Suppl 9):S1–S9Google Scholar
  11. 11.
    Rammelt S, Dürr C, Schneiders W, Zwipp H (2012) Minimally invasive fixation of calcaneal fractures. Oper Orthop Traumatol 24:383–395. CrossRefGoogle Scholar
  12. 12.
    Wong DW, Niu W, Wang Y, Zhang M (2016) Finite element analysis of foot and ankle impact injury: risk evaluation of calcaneus and talus fracture. PLoS ONE 11(4):e0154435. CrossRefGoogle Scholar
  13. 13.
    Borrelli J Jr, Torzilli PA, Grigiene R, Helfet DL (1997) Effect of impact load on articular cartilage: development of an intra-articular fracture model. J Orthop Trauma 11:319–326CrossRefGoogle Scholar
  14. 14.
    Gorbachova T, Wang PS, Hu B, Horrow JC (2016) Plantar talar head contusions and osteochondral fractures: associated findings on ankle MRI and proposed mechanism of injury. Skeletal Radiol 45:795–803. CrossRefGoogle Scholar
  15. 15.
    Yu X, Pang QJ, Chen L, Yang CC, Chen XJ (2014) Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation: a review. J Int Med Res 42:17–25. CrossRefGoogle Scholar
  16. 16.
    Sanders R, Vaupel ZM, Erdogan M, Downes K (2014) Operative treatment of displaced intraarticular calcaneal fractures: long-term (10–20 Years) results in 108 fractures using a prognostic CT classification. J Orthop Trauma 28:551–563. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Chayanin Angthong
    • 1
    Email author
  • Andrea Veljkovic
    • 2
  • Wirana Angthong
    • 3
  • Prasit Rajbhandari
    • 4
  1. 1.Foot and Ankle Surgery Unit, Department of Orthopaedics, Faculty of MedicineThammasat UniversityPathum ThaniThailand
  2. 2.Department of OrthopaedicsUniversity of British ColumbiaVancouverCanada
  3. 3.Department of Radiology, Faculty of MedicineThammasat UniversityPathum ThaniThailand
  4. 4.Department of OrthopedicsGrande International HospitalKathmanduNepal

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