Objective：Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open...Objective：Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate.Methods：In this series,28 patients （26 unilateral and 2 bilateral） with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury.Patients were evaluated in terms of associated injuries and X-rays of anteroposterior,lateral and axial views of the calcaneum.CT scan was done to assess the amount ofcomminution and articular depression.Patients were followed up clinically and radiologically at least for 1 year.Radiological assessment was done by Bohler＇s angle and Gissane＇s angle along with measurement ofcalcaneal height and width.Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society （AOFAS） scale.Results：At average follow-up of 14.5 months,average AOFAS score was 86.3 （range 66 to 97）,with 86% having excellent to good results and 2 （7.7%） and 1 （3.7%） having fair and poor results respectively.All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°.Average subtalar range of motion was 17°.The mean Bohler＇s angle,mean Gissane＇s angle,calcaneal height and width were 25.47°,121.3°,4.32 cm and 3.81cm respectively at final follow-up.Three patients had flap necrosis at incision site and one had superficial and deep infection.Subtalar arthritis was seen in 5 patients,whereas sural nerve hypoaesthesia in 1 patient.None of the patients had compartment syndrome,heel pad problems,peroneal tendinitis,reflex sympathetic dystropy or implant failure.Conclusion：Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome,i.e.restoring anatomically reconstruction of height,width,Bohler＇s and Gissiane＇s angles of the calcaneum,and allowing early mobilization.展开更多
Purpose： To compare the efficacy of percutaneous poking reduction and fixation with open reduction and fixation in the treatment of displaced calcaneal fractures. Methods： Reports of studies using case-controlled tr...Purpose： To compare the efficacy of percutaneous poking reduction and fixation with open reduction and fixation in the treatment of displaced calcaneal fractures. Methods： Reports of studies using case-controlled trials （CCT） to compare the percutaneous poking reduction and fixation with the open reduction and fixation in the management of calcaneal fractures were retrieved from the Cochrane Library, PubMed Database, CNKI, Chinese Biomedical Database, Wanfang Data （fromJanuary of 2005 to August of 2015）. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.0 was used for data-analysis. Results： Fifteen articles were included in the meta-analysis. Comparison of the efficacy of percutaneous poking reduction and fixation with open reduction and fixation in the treatment of calcaneal fractures revealed statistical significance in the incidence of complications after operation [RR -- 0.32, 95,~ Cl （0.20, 0.5）, p 〈 0.05]. However, there were neither statistical significance in the degrees of recovery for calcaneal Bohler angle [WMD = -1.65, 95% CI （ 3.43, 0.14）, p 〉 0.05] and calcaneal Gissane angle [WMD - -3.21, 95%, Cl （-6.75, 0.33）, p 〉 0.05], nor statistical significance in the rate of good foot function after operation [RR = 0.95, 95Z Cl （0.90, 1.00）, p 〉 0.05]. Conclusion： For the treatment of calcaneal fractures, percutaneous poking reduction and fixation is superior to open reduction and fixation in terms of the incidence of postoperative complications. But both techniques can obtain satisfactory clinical function.展开更多
文摘Objective：Debate continues regarding the management of calcaneal fractures,between open reduction and internal fixation and closed treatment.Hence we aim at evaluating the radiological and functional outcomes of open reduction and internal fixation in displaced joint depression type of calcaneal fractures fixed with locking calcaneal plate.Methods：In this series,28 patients （26 unilateral and 2 bilateral） with joint depression type of calcaneal fractures as per Essex-Lopresti classification system were operated on with locking calcaneal plate within 3 weeks of injury.Patients were evaluated in terms of associated injuries and X-rays of anteroposterior,lateral and axial views of the calcaneum.CT scan was done to assess the amount ofcomminution and articular depression.Patients were followed up clinically and radiologically at least for 1 year.Radiological assessment was done by Bohler＇s angle and Gissane＇s angle along with measurement ofcalcaneal height and width.Functional outcome was assessed using the American Orthopaedics Foot and Ankle Society （AOFAS） scale.Results：At average follow-up of 14.5 months,average AOFAS score was 86.3 （range 66 to 97）,with 86% having excellent to good results and 2 （7.7%） and 1 （3.7%） having fair and poor results respectively.All patients had stable ankle joint with all having dorsiflexion and plantar flexion more than 30°.Average subtalar range of motion was 17°.The mean Bohler＇s angle,mean Gissane＇s angle,calcaneal height and width were 25.47°,121.3°,4.32 cm and 3.81cm respectively at final follow-up.Three patients had flap necrosis at incision site and one had superficial and deep infection.Subtalar arthritis was seen in 5 patients,whereas sural nerve hypoaesthesia in 1 patient.None of the patients had compartment syndrome,heel pad problems,peroneal tendinitis,reflex sympathetic dystropy or implant failure.Conclusion：Open reduction and internal fixation with locking calcaneal plate gives sound functional outcome,i.e.restoring anatomically reconstruction of height,width,Bohler＇s and Gissiane＇s angles of the calcaneum,and allowing early mobilization.
基金This study was funded by the National Natural Science Foundation of China （No. 81572098）.
文摘Purpose： To compare the efficacy of percutaneous poking reduction and fixation with open reduction and fixation in the treatment of displaced calcaneal fractures. Methods： Reports of studies using case-controlled trials （CCT） to compare the percutaneous poking reduction and fixation with the open reduction and fixation in the management of calcaneal fractures were retrieved from the Cochrane Library, PubMed Database, CNKI, Chinese Biomedical Database, Wanfang Data （fromJanuary of 2005 to August of 2015）. Methodological quality of the trials was critically assessed, and relevant data were extracted. Statistical software Revman 5.0 was used for data-analysis. Results： Fifteen articles were included in the meta-analysis. Comparison of the efficacy of percutaneous poking reduction and fixation with open reduction and fixation in the treatment of calcaneal fractures revealed statistical significance in the incidence of complications after operation [RR -- 0.32, 95,~ Cl （0.20, 0.5）, p 〈 0.05]. However, there were neither statistical significance in the degrees of recovery for calcaneal Bohler angle [WMD = -1.65, 95% CI （ 3.43, 0.14）, p 〉 0.05] and calcaneal Gissane angle [WMD - -3.21, 95%, Cl （-6.75, 0.33）, p 〉 0.05], nor statistical significance in the rate of good foot function after operation [RR = 0.95, 95Z Cl （0.90, 1.00）, p 〉 0.05]. Conclusion： For the treatment of calcaneal fractures, percutaneous poking reduction and fixation is superior to open reduction and fixation in terms of the incidence of postoperative complications. But both techniques can obtain satisfactory clinical function.
