A Biomechanical Comparison of Conventional versus an Anatomic Plate and Compression Bolts for Fixation of Intra-articular Calcaneal Fractures

The purpose of this study was to compare the biomechanical stability obtained by using our technique featured an anatomical plate and compression bolts versus that of the conventional anatomic plate and cancellous screws in the fixation of intraarticular calcaneal fractures.Eighteen fresh frozen lower limbs of cadavers were used to create a reproductive Sanders type-Ⅲ calcaneal fracture model by using osteotomy.The calcaneus fractures were randomly selected to be fixed either using our anatomical plate and compression bolts or conventional anatomic plate and cancellous screws.Reduction of fracture was evaluated through X radiographs.Each calcaneus was successively loaded at a frequency of 1 Hz for 1000 cycles through the talus using an increasing axial force 20 N to 200 N and 20 N to 700 N,representing the partial weight bearing and full weight bearing,respectively,and then the specimens were loaded to failure.Data extracted from the mechanical testing machine were recorded and used to test for difference in the results with the Wilcoxon signed rank test.No significant difference was found between our fixation technique and conventional technique in displacement during 20-200 N cyclic loading(P=0.06),while the anatomical plate and compression bolts showed a great lower irreversible deformation during 20-700 N cyclic loading(P=0.008).The load achieved at loss of fixation of the constructs for the two groups had significant difference:anatomic plate and compression bolts at 3839.6±152.4 N and anatomic plate and cancellous screws at 3087.3±58.9 N(P=0.008).There was no significant difference between the ultimate displacements.Our technique featured anatomical plate and compression bolts for calcaneus fracture fixation was demonstrated to provide biomechanical stability as good as or better than the conventional anatomic plate and cancellous screws under the axial loading.The study supports the mechanical viability of using our plate and compression bolts for the fixation of calcaneal fracture.

The Use of Calcaneal Anatomic Plate in Arthroscopically-assisted Open Reduction and Internal Fixation of Intra-articular Calcaneal Fractures

To discuss and evaluate the method and effect of using calcaneal anatomic plate in treatment of intra-articular fractures of the calcaneus with assistant of arthroscope, 86 intra-articular fractures of the calcaneus in 78 patients were reduced by open reduction, and rigid fixation was made with calcaneal anatomic plate under assistant of arthroscope. The average follow-up duration was 18 months （range 12-30 months）. The effect of treatment was evaluated according to AOFAS and X-ray before and after operation. The results showed that 86 patients have obtained satisfactory reduction according to X-ray, and there was significant difference before and after operation （P〈0. 01）, the total excellent and fine rate was 91.86%. Treating intra-articular fractures of the calcaneus with calcaneal anatomic plate under arthroscope may provide more chance to achieve anatomical reconstruction, which can lead to satisfied recovery of function and few complication.

First Ever Documented Total Calcaneus Replacement with 3D Printed Metallic Implant for Chronic Osteomyelitis after a Calcaneal Fracture in a Young, Healthy Individual—A Literature Review and Preliminary Case Report

Osteomyelitis of the calcaneus can be a limb threatening diagnosis, which is typically treated with antibiotic therapy with or without partial resection of the bone. Extensive infection of the bone commonly results in limb amputation via transtibial or transfemoral amputation, which can increase morbidity and mortality. This case report involves a 29-year-old male who sustained bilateral calcaneal fracture after a fall, who developed osteomyelitis of the right calcaneus after being treated with internal/external fixation and antibiotic therapy. In order to preserve the limb total calcaneal replacement with 3D printed implant was done.

Fixation of Calcaneal Tuberosity Beavis II Fracture in Elderly Patients Using Locking Plate Combined with Tension Screw

Background:Calcaneus is the largest bone of foot and the main load-bearing structure of heel.The incidence of simple calcaneal tubercle avulsion fracture is low,accounting for about 1%to 3%of all calcaneal fractures.Beavis II fracture has large bone fracture,obvious displacement,obvious soft tissue irritation,and often leads to skin necrosis.It needs surgical treatment,reduction and fixation as soon as possible.Although open reduction and tension screw internal fixation is used for Beavis II calcaneal tubercle fracture,but the failure rate is more common.Methods:This study retrospectively analyzed the surgical treatment of calcaneal tubercle Beavis II fracture over 55 years old in our hospital from January 2013 to January 2019.The patients were treated with tension screw combined with locking plate,and followed up and analyzed.Results:12 patients in this group were followed up for 12 to 36 months(mean 20 months).After operation,the fracture healed smoothly in all patients,the healing time was 8 to 12 weeks(mean 10.7 weeks),and there were no complications such as poor incision healing,fracture displacement,internal fixation loosening,fracture and so on.When the patients were followed up 18 weeks after operation,the AOFAS score was 47 to 100,with an average of 91.1,of which 8 cases were excellent,3 good and 1 poor,with an excellent and good rate of 91.7%.Conclusion:Our hospital has been treated with tension screw combined with locking plate,fixed firmly,can early functional exercise,achieved good results.

Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures

The locking plate and percutaneous crossing metallic screws and crossing absorbable screws have been used clinically to treat intra-articular calcaneal fractures, but little is known about the biomechanical differences between them. This study compared the biomechanical stability of calcaneal fractures fixed using a locking plate and crossing screws. Three-dimensional finite-element models of intact and fractured calcanei were developed based on the CT images of a cadaveric sample. Surgeries were simulated on models of Sanders type III calcaneal fractures to produce accurate postoperative models fixed by the three implants. A vertical force was applied to the superior surface of the subtalar joint to simulate the stance phase of a walking gait. This model was validated by an in vitro experiment using the same calcaneal sample. The intact calcaneus showed greater stiffness than the fixation models. Of the three fixations, the locking plate produced the greatest stiffness and the highest von Mises stress peak. The micromotion of the fracture fixated with the locking plate was similar to that of the fracture fixated with the metallic screws but smaller than that fixated with the absorbable screws. Fixation with both plate and crossing screws can be used to treat intra-articular calcaneal fractures. In general, fixation with crossing metallic screws is preferable because it provides sufficient stability with less stress shielding.

Operative vs nonoperative treatment of displaced intraarticular calcaneal fracture: A meta-analysis of randomized controlled trials

AIM： To investigate clinical efficacy of displaced intra-articular calcaneal fracture （DIACF） following operation and nonoperation. METHODS： Literature search was performed of PubMed and Cochrane Library by two independent authors to identify randomized controlled trials （RCTs） comparing operative vs nonoperative treatment of DIACF from inception to December 31st, 2013. RCT quality was evaluated by the modified Jadad scale. Dichotomous variables were pooled using risk ratios by review manager 5.3 software. Fixed-effects or random-effects models were adopted with P 〉 0.05 or P ≤ 0.05 for heterogeneity tests, respectively.RESULTS： Eight RCTs comprising 767 cases met inclusion criteria. Results revealed that more surgically treated patients could resume pre-injury job （P = 0.006）. No statistical differences were found between the two groups in residual pain （P = 0.33）, shoe fitting problems （P = 0.07）, limited walking distance （P = 0.56） or secondary late arthrodesis （P = 0.38）. However, operative treatment was associated with a higher complication rate （P = 0.003）. Subgroup analyses of specific complications revealed that except for a higher risk of superficial wound problems （P 〈 0.0001） in operative group, the two groups had similar complication rate in deep wound infection （ P = 0.34）,CONCLUSION： Current evidence demonstrates that compared with operative treatment, conservative treatment of DIACF lead to similar clinical outcomes regarding residual pain, shoe fitting, walking distance and secondary subtalar arthrodesis but a significantly lower complication rate.

Spontaneous calcaneal fracture in patients with diabetic foot ulcer: Four cases report and review of literature

Spontaneous calcaneal fractures in diabetic patients without obvious trauma may occur, sometimes accompanying diabetic foot ulcers. In the current study we report four cases who were hospitalized for diabetic foot ulcer with concomitant calcaneal fractures. There were four diabetic patients(one type 1 and three type 2) who registered with diabetic foot ulcers with coexisting calcaneal fractures, all of which were classified as Type A according to Essex Lopresti Calcaneal Fracture Classification. Two of the patients with renal failure were in a routine dialysis program, as well as vascular compromise and osteomyelitis in all of the patients. The diabetic foot ulcer of the 61 years old osteoporotic female patient healed with local debridement, vacuum assisted closure and then epidermal growth factor while the calcaneal fracture was then followed by elastic bandage. In two patients could not prevent progression of diabetic foot ulcers and calcaneal fractures to consequent below-knee amputation. The only patient with type 1 diabetes mellitus improved with antibiotic therapy and split thickness skin grafting, while the calcaneal fracture did not heal. In the current study we aimed to emphasize the spontaneous calcaneal fractures as possible co-existing pathologies in patients with diabetic foot ulcers. After all the medical treatment, amputation below knee had to be performed in 2 patients. It should be noted that other accompanying conditions such as impaired peripheral circulation, osteomyelitis, chronic renal failure, and maybe osteoporosis is a challenge of the recovery of calcaneal fractures and accelerate the progress to amputation in diabetic patients.

Ilizarov external fixators for maluninon of obsolete calcaneal fracture of Stephen Type Ⅲ

Objective To evaluate the clinical effects of Ilizarov external fixator for maluninon of obsolete calcaneal fracture of Stephen Type Ⅲ.Methods From July 2006 to February 2009,25 patients suffering from maluninon of obsolete calcaneal

External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius （IFDR） in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after I week and 3, 6 and 12 months. After 3 months, the plating group had better pronation （P = 0.001）, supination, （P = 0.047） and extension （P = 0.043） scores. These differences were somewhat attenuated by 6 months and disappeared at I year. The plating group had a greater occurrence of wound infection （P = 0.043）, tendonitis, （P = 0.024） and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the ＂gross motor＂ category （walking upstairs, bending over, walking 500 yards; P = 0.023）. Internal fixation was more advantageous than external fixation in the early rehabilitation period; after I year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries.

Is Wound Complication a Deterrent to Lateral Extensile Approach in Calcaneus Fracture?

Introduction: The lateral extensile approach has been a widely accepted surgical approach in treatment of intraarticular calcaneal fracture. It provides good exposure for fixation by correcting the hindfoot varus, fracture reduction and restores calcaneal height but it has a high wound complication rate. Methods and materials: 36 intraarticular calcaneal fractures (Sanders II, III and IV) treated using the lateral extensile approach in 34 patients presenting between 2015 and 2018 were retrospectively reviewed. Wound complication in the early stage (day 1 to day 3), intermediate (2 weeks) and late (6 weeks) were documented. Results: We found early (Day 1 - Day 3) infection rate of 5.6%, intermediate (2 weeks) at 17.6% and late wound complication (6 weeks) at 2.9%. Conclusion: Lateral expansile approach is a reliable surgical exposure for fracture reduction of calcaneal fractures with acceptable wound related complication rate. Minimally invasive techniques and the sinus tarsi approach are being used for less comminuted fractures, but those techniques are technically more demanding. Smoking, long duration of surgery and soft tissue handling also play a role in increasing wound complication rates.

Total knee arthroplasty and fractures of the tibial plateau

Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation(ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty(TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.

Dynamic External Fixator Combined with Volar Locking Plate Fixation for the Treatment of AO Type C3 Distal Radius Fractures

Background: AO type C3 distal radius fracture (DRF) is the most difficult-to-treat fracture type because of a tendency to shorten and collapse. The purpose of this study is to investigate the clinical and radiographic outcomes of comminuted intra-articular DRFs treated with a dynamic external fixator combined with a volar locking plate (VLP). Methods: Eleven patients (mean age, 61 years) with comminuted intra-articular DRFs were treated with a dynamic type of external fixator combined with a VLP. Following reduction and fixation with a VLP, the dynamic external fixator was applied and the distal ball joint of the fixator was aligned with the lunate-capitate line. The ball joint was unlocked approximately 2 weeks after surgery to allow wrist mobilization. The fixator was removed 3 - 6 weeks (mean, 5 weeks) after surgery. Consequently, clinical and radiographic assessments were carried out at the final follow-up. Results: At the final follow-up, the mean range values of wrist extension and flexion were 76°and 64°, respectively. Compared with the contralateral side, the mean grip strength was 84%. The mean Modified Mayo Wrist Score and the Disabilities of the Arm, Shoulder and Hand score were 88 and 9, respectively. No significant differences in the radiographic parameters exist between after surgery and final follow-up. Conclusions: This study indicated that the dynamic wrist fixator combined with a VLP is effective for the treatment of AO type C3 DRFs.

1例先天性无痛无汗症合并跟骨骨折患儿的护理

总结1例先天性无痛无汗症合并跟骨骨折患儿的围术期护理。护理要点主要包括:充分的入院评估和宣教、保持皮肤完整性、高热的处理、石膏的护理、个性化的功能锻炼、详细的出院指导和延续性护理等。经过全方位的评估和诊疗,最终给予患儿石膏靴外固定保守治疗,患儿体温平稳、皮肤无破损,于5 d后出院。对其随访8个月,患肢功能恢复良好,不影响日常生活。

超声引导下股神经、坐骨神经阻滞在跟骨骨折手术麻醉中的应用效果

目的:探究超声引导下股神经、坐骨神经阻滞在跟骨骨折手术麻醉中的应用效果。方法:选取2020年2月—2023年2月菏泽医学专科学校附属医院收治的跟骨骨折患者80例,以随机数字表法将其均分为对照组(椎管内麻醉)及观察组(超声引导下股神经、坐骨神经阻滞)各40例,对比两组麻醉效果;对比两组麻醉前(T_(0))、麻醉后5 min(T_(1))、麻醉后10 min(T_(2))、麻醉后15 min(T_(3))、麻醉后30min(T_(4))时刻的心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO_(2));对比两组应激反应指标[肾上腺素(E)、皮质醇(Cor)]、凝血功能[凝血酶时间(TT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)]、不良反应发生率。结果:观察组麻醉效果Ⅰ级率高于对照组,差异有统计学意义(P<0.05)。两组T_(0)、T_(1)时刻HR、MAP、SpO_(2)水平比较差异均无统计学意义(P>0.05);对照组T_(2)、T_(3)、T_(4)时刻HR、MAP均高于T_(0)时刻,SpO_(2)均低于T_(0)时刻,差异均有统计学意义(P<0.05);观察组T_(2)、T_(3)、T_(4)时刻HR、MAP、SpO_(2)较T_(0)时刻差异均无统计学意义(P>0.05);观察组T_(2)、T_(3)、T_(4)时刻HR、MAP均低于对照组,SpO_(2)均高于对照组,差异均有统计学意义(P<0.05)。术前,两组E、Cor水平相较差异均无统计学意义(P>0.05);术后1 h两组E、Cor水平均升高,但观察组均低于对照组,差异均有统计学意义(P<0.05)。术前,两组TT、PT、APTT水平相较差异均无统计学意义(P>0.05);术后1 h,两组TT、PT、APTT水平均升高,且观察组均高于对照组,差异均有统计学意义(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论:对跟骨骨折患者实施超声引导下股神经、坐骨神经阻滞,麻醉效果显著,减轻应激反应,稳定术中血流动力学,改善血液高凝状态,降低并发症发生率。

不同治疗方式对于跟骨骨折手术情况及预后的影响

为研究不同治疗方式对于跟骨骨折手术情况及预后的影响。选择80例跟骨骨折患者为研究对象,根据随机数字分配方法,将他们分成两组。A组采用经皮撬拨手法复位结合有限切开钛板固定术治疗,B组采用足外侧“L”形切口复位内固定术。对两组患者术后并发症等各项指标进行比较。结果表明:两组术前术后Bohler角、跟骨宽度、Gissane角、Maryland足部功能评分比较,差异无统计学差异(P>0.05)。组内比较,两组患者经过治疗后,Bohler、Gissane角和跟骨中部宽度均高于治疗前,差异有统计学意义(P<0.05);两组的治疗时间、术中出血量和术后并发症的发生率均有显著性差异(P<0.05)。在跟骨骨折的治疗中,用两种不同方式进行对比分析,经皮撬拨手法固定治疗方式,能够获得较满意的解剖复位,且稳定性可靠,跗骨窦入路较外侧L形切口入路创伤小,可有效避免皮缘坏死和感染的发生,更有利于提高患者的临床疗效。

跗骨窦小切口与经外侧“L”形切口术对跟骨骨折患者的疗效

目的 比较跗骨窦小切口与经外侧“L”形切口术治疗跟骨骨折的疗效及对足功能恢复情况的影响。方法 研究对象选取2020年10月至2022年10月收治的跟骨骨折患者88例,按照手术方法分为对照组43例,研究组45例,对照组采用经外侧“L”形切口术,研究组采用跗骨窦小切口手术。检测比较2组手术情况及并发症发生情况、足功能、跟骨解剖结构、骨代谢、炎性因子、应激反应指标水平。结果 与对照组比较,研究组术后引流量、术中出血量较少,手术、住院及骨折愈合时间较短,并发症发生率较低(P<0.05)。与术前比较,术后3个月2组AOFAS评分、Bohler角、Gissane角、跟骨长度、跟骨高度、P1NP、骨特异性碱性磷酸酶(BALP)水平升高,且研究组高于对照组,抗酒石酸酸性磷酸酶(TRAP)、环磷酰胺(CTX)水平降低,且研究组低于对照组(P<0.05)。与术前比较,术后3 d 2组CRP、IL-6、MDA水平升高,但研究组低于对照组,SOD水平降低,但研究组高于对照组(P<0.05)。结论 跗骨窦小切口术治疗跟骨骨折效果理想,可减少手术创伤,减轻炎症及应激反应,且可促进术后足功能、骨代谢恢复,并发症少。

切开复位空心螺钉结合锚钉固定术治疗糖尿病合并跟骨结节撕脱骨折的疗效观察

目的探讨糖尿病合并跟骨结节撕脱性骨折患者实施切开复位空心螺钉结合锚钉固定术(open reduction and internal fixation,ORIF)的效果。方法回顾性研究2020年8月—2022年4月北京丰台医院收治的22例糖尿病合并跟骨结节撕脱性骨折的患者,采用切开复位空心螺钉结合锚钉固定术治疗。围手术期及术后进行血糖的评估;术后随访使用足踝关节预后评分(foot and ankle outcome score,FAOS)、视觉模拟量表(visual analogue scale,VAS)、单脚跟抬高测试和X射线图像进行评估。结果所有骨折均在解剖位置愈合,没有出现术后固定失败、内固定松动移位以及皮肤感染、坏死等情况。术后随访6~8个月,所有患者都恢复了完全的足底屈曲范围和力量,没有步态异常或负重限制。FAOS评分:疼痛(80.85±6.20)分,症状(79.85±4.90)分,日常生活(72.35±8.00)分,运动和娱乐功能(68.25±11.93)分,足踝活动影响(77.47±6.70)分。VAS评分为(2.16±0.30)分。结论切开复位空心螺钉结合锚钉固定术是治疗糖尿病相关跟骨结节撕脱性骨折的有效手段,并显示出良好的功能和影像学结果。

3D打印导板结合跟骨钉中钉与传统外侧“L”形切口钢板内固定治疗跟骨骨折的疗效

目的探究3D打印导板结合跟骨钉中钉与传统外侧“L”形切口钢板内固定治疗跟骨骨折的疗效。方法回顾性分析2020年1月至2022年1月滨州市中心医院收治的30例单侧SandersⅡ~Ⅲ型跟骨骨折患者作为研究对象,根据固定方式不同分为传统手术组(n=18)与3D打印跟骨钉中钉组(n=12)。传统手术组采用传统外侧“L”形切口钢板内固定治疗,3D打印跟骨钉中钉组采用3D打印导板结合跟骨钉中钉治疗。比较两组内固定效果、手术时间、术中出血量、Gissane角、Böhler角、跟骨宽度、并发症发生情况及疼痛程度。结果两组优良率均为100.00%,组间比较差异无统计学意义;3D打印跟骨钉中钉组手术时间短于传统手术组,术中出血量少于传统手术组,差异有统计学意义(P<0.05);术后,两组Gissane角均小于术前,Böhler角大于术前,跟骨宽度窄于术前(P<0.05),但组间比较差异无统计学意义;3D打印跟骨钉中钉组并发症发生率为8.33%,低于传统手术组的44.44%,差异有统计学意义(P<0.05);术后,两组视觉模拟评分法(VAS)评分均低于术前,且3D打印跟骨钉中钉组低于传统手术组,差异有统计学意义(P<0.05)。结论两种手术方式均为治疗跟骨骨折有效手术方式,3D打印导板结合跟骨钉中钉治疗跟骨骨折可有效减少术中出血,缩短手术时间,降低术后并发症发生率,值得临床推广应用。

3D打印联合跗骨窦下小切口空心钉内固定治疗创伤性跟骨骨折的效果

目的:探究3D打印联合跗骨窦下小切口空心钉内固定治疗创伤性跟骨骨折的效果。方法:选择2019年1月—2023年1月在贵州省人民医院治疗的创伤性跟骨骨折患者120例,应用随机数字表法将其分为对照组(行跗骨窦下小切口空心钉内固定)及观察组(行3D打印联合跗骨窦下小切口空心钉内固定),各60例。对比两组临床效果、围手术期指标(手术时间、出血量、透视次数)、影像学指标(跟骨Bhler角、Gissane角、跟骨高度、跟骨长度、跟骨宽度)、踝关节功能(踝-后足评分)、炎症因子[肿瘤坏死因子-α(TNF-α)、白细胞介素-1(IL-1)、C反应蛋白(CRP)]、应激反应[皮质醇(Cor)、去甲肾上腺素(NE)、血管紧张素Ⅱ(AngⅡ)]。结果:观察组优良率高于对照组,手术时间短于对照组,透视次数、出血量均少于对照组,差异均有统计学意义(P<0.05)。术后,两组Bhler角、Gissane角、跟骨高度、跟骨长度、跟骨宽度与术前比较,差异均有统计学意义(P<0.05);两组术后以上指标比较,差异均无统计学意义(P>0.05)。术后,两组踝-后足评分均升高,观察组高于对照组,TNF-α、IL-1、CRP、Cor、NE、AngⅡ水平均显著升高,但观察组均低于对照组,差异均有统计学意义(P<0.05)。结论:3D打印联合跗骨窦下小切口空心钉内固定治疗创伤性跟骨骨折,可减轻手术创伤,减轻炎症反应、应激反应,促进踝关节功能恢复。

外侧横弧形切口和扩大L形切口切开复位内固定手术治疗粉碎性跟骨骨折的临床效果

目的:分析外侧横弧形切口和扩大L形切口切开复位内固定手术治疗粉碎性跟骨骨折的临床效果。方法:回顾性选取2019年9月—2022年12月杭州师范大学附属医院收治的102例粉碎性跟骨骨折患者。根据患者手术入路的不同将其分为观察组(59例)和对照组(43例)。对照组给予外侧横弧形切口切开复位内固定手术。观察组给予扩大L形切口切开复位内固定手术。比较两组围手术期指标、并发症、切口愈合情况、相关指标。结果:观察组手术时间及切口愈合时间、切口长度均长于对照组,手术失血量多于对照组,差异有统计学意义(P<0.05)。两组术后并发症发生率比较,差异无统计学意义(P>0.05)。两组切口愈合情况比较,差异无统计学意义(P>0.05)。术后1个月、10个月,观察组Barthel指数、美国足踝外科协会踝与后足功能(American Orthopaedic Foot and Ankle Society,AOFAS)评分均高于对照组;术后1个月,观察组视觉模拟评分法(visual analogue scale,VAS)评分高于对照组,术后10个月,VAS评分低于对照组;术后10个月观察组复位率高于对照组,差异有统计学意义(P<0.05)。结论:粉碎性跟骨骨折行切口复位内固定手术治疗中,扩大L形切口手术损伤相对高于外侧横弧形切口,但是并未增加安全性风险,且复位效果与恢复结果更佳。