Intra-articular calcaneal fracture fixation for the treatment and complications

     Author: PAN Yong-Tai Xu Jian-Qiu Qiu-Lin Zhang Wen-Zhong Zheng Xiao Yi

    Zeng Huang Chunfu root

     【Key Words】 fracture fixation

     Abstract: [Objective] to improve plate fixation of intra-articular calcaneal fracture

    surgery, reduce operative complications. [Methods] calcaneal fractures treated with open reduction and plate fixation of 51 patients were followed up, and complications were analyzed retrospectively. [Results] 51 patients with 56 feet, 47 foot fracture healing fine, 6 foot poor postoperative reduction, malformation healing, incision delayed healing, infection and other complications rate was 11.7%. [Conclusion] open reduction and plate fixation can be affected from the treatment of articular calcaneal fractures under the main method of intraoperative attention to operational detail, anatomical reduction can reduce complications.

     Keywords: Calcaneus; fracture fixation; complications

     The treatment of intraarticular calcaneal fractures with interal fixation and the following complications

     Abstract: [Objective] To study how to decrease the complications and improve efficacy of the open reduction and internal fixation (ORIF) with plate for intraarticular

    calcaneal fractures. [Method] Fiftyone patients (56 feet), treated with ORIF, were followed up for 6 to 36 months, and the associated complications were analyzed retrospectively. [Result] Complications were found in 6 cases, including postoperative

    wound dehiscence in 2 (infection in 1), malunion (failure to achieve reduction) in 4.The percentage of complication was 11.7%. [Conclusion] ORIF with plate could be the main treatment for intraarticular calcaneal fractures. Should attention be paid to the

    detail skill and anatomical reduction, many complications could be avoided.

     Key words Calcaneus; Fracture fixation; Complication

     Calcaneal fracture is a common foot injuries, tarsal bone fractures accounted for

    60% ~ 65%, 2% of all fractures [1,2]. Intra-articular fractures accounted for 70% of

    all calcaneal fractures. The most common injury calcaneal fractures due to fall height, often accompanied by spinal fracture. With the recent development of transportation

    and construction are on the rise.

     This paper analyzed retrospectively from June 1999 ~ June 2004, 58 patients (64 feet) were carried out in open reduction of calcaneal fracture fixation plate to be analyzed. Which 51 patients (56 feet) were followed up, with a total effective rate was 88.4%, with

    9 feet there are different complications reported are summarized below.

     1 Data and methods

     1.1 General Information

     The group of 51 patients (56 feet), 43 males and 8 females, bilateral in 5 cases, aged

    21 to 56 years, with an average 34.5 years of age. Cause of his injuries: 39 cases of height fall injuries, traffic accidents in 12 cases. Associated injuries: The 12 patients with thoracic spine fractures, one cases of splenic rupture, and rib fracture, 2 cases of

    pelvic fracture associated with traumatic shock, 1 case of tibial plateau fractures. Between injury and surgery: 1 ~ 21d, an average of 7.6d. 56 feet are affected to varying degrees of subtalar displacement of the calcaneus associated with blunt injury.

    Fracture classification: According to Sanders classification standard: ? fracture of 15

    feet, ? fracture 31 feet, ? fracture of 10 feet. Are in the body in stable condition, within 24h after injury, or swelling subsided Across heel surgery; the day of surgery

    and no obvious swelling in patients plus with 20% mannitol dehydration. Preoperative lateral increases shooting heel is axial X-ray, CT scan calcaneus, conditional underwent

    ipsilateral calcaneus three-dimensional CT reconstruction. Type ? or ? fracture

    patients with autogenous iliac bone graft.

     1.2 fixation materials

     Universal (international) medical equipment provided by "Y" or "H"-shaped

    reconstruction plate.

     1.3 surgical

     Use of outside "L"-shaped incision, longitudinal-shaped incision is located between

    the Achilles tendon and the peroneal tendon length, the horizontal incision in the lateral malleolus and the plantar skin between the apex. After the skin incision, from the subperiosteal tilting flap (flap inside to protect the sural nerve), a chain opened

    peroneus longus, brevis tendon, joint and calcaneus revealed subtalar joints, looking for the fracture line, identify fracture of articular surface . Set out from the sudden displacement of articular surface of the lateral compression of the intra-articular

    fracture of blocks. First varus calcaneus nodules, while downward traction, and then turned outward, and to correct the heel varus shortening and the calcaneal tubercle to the medial wall of the calcaneus reset, with the Kirschner wire to maintain reduction. And then remove the pieces of the articular surface fracture reduction, and to restore Gissane angle, Bhler angle and calcaneal articular surface, pinning the fracture block.

    Perspective check the location of fracture, particularly in view Broden bit after the articular surface of the calcaneus is completely reset. ? ? fracture or most severe

    compression fractures, cavities large, need to take iliac bone graft. Reset satisfied, according to fracture type, degree and subtalar joints crush injuries, choose the right heel plate, fixed calcaneus, the lateral wall fracture blocks, nodular fracture blocks and blocks of post-articular fractures, the application screw fixation lateral wall of the block to set out from the sudden fracture of cortical bone on the next to ensure that the fixed solid and corroborating. The exact fixation of the Kirschner wire after the removal of the temporary fixation, place the drainage of the wound drainage. Need to

    add a small number of severe comminuted fracture of the medial incision to assist with the reduction and fixation.

     1.4 Postoperative management

     Routine use of antibiotics 5 ~ 7d, 20% mannitol dehydration and foot elevation 3 ~ 5d, to facilitate the swelling. Active practice after ankle and toe-activity, after 3 months

    after a gradual weight-bearing.

     2 Results

     Patients were followed up 6 to 36 months, an average of 13.6 months. 56 foot fractures healed, plate and screw without broken foot look normal, walking and

    flexible no obvious pain. After the AOFAS ankle score according to the standard [3], average score 86.5 points (out of 100 points), joint function excellent rate of 88.4%. After a total of 6 foot complications: a result of the earlier incision suture removal in 1

    case, superficial infection in 1 case with skin flap necrosis; fractures poor, deformed healing in 4 cases, 1 case of Bhler angle