SURGICAL TREATMENT OF CALCANEAL FRACTURE INVOLVING TALOCALCANEAL AND CALCANEOCUBOID JOINTS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAO Lihai , PENG Yi , YAN Rongliang , WANG Hongtao.

Department of Foot and Ankle Surgery, the Second Hospital of Tangshan, Tangshan Hebei, 063000, P.R.China. Corresponding author: CAO Lihai, E-mail: caolihai@126.com;

Corresponding author：

Keywords：

Calcaneal fracture; Talocalcaneal joint; Calcaneocuboid joint; U-shaped incision; Internal fixation

DOI：

10.7507/1002-1892.20130038

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Objective To explore the method and effectiveness of lateral calcaneal U-shaped incision approach to treat calcaneal fractures involving the talocalcaneal and calcaneocuboid joints. Methods Between January 2009 and March 2011, 36 cases of calcaneal fractures involving the talocalcaneal and calcaneocuboid joints were treated by the lateral calcaneal U-shaped incision approach and calcaneal anatomical plate fixation. There were 27 males and 9 females with an average age of 38.7 years (range, 19-58 years). According to the Sanders classification criteria, there were 12 cases of type II, 20 cases of type III, and 4 cases of type IV. The B ouml;hler and Gissane angles were (6.21 ± 10.48)° and (89.85 ± 12.34)°, respectively. The average time from injury to surgery was 4.2 days (range, 2-14 days). Results Superficial skin flap necrosis and wound exudate occurred in 1 case respectively, which were cured after dressing change; primary healing was obtained in the other cases. All the cases were followed up 12-26 months (mean, 15.2 months). The X-ray films showed that all fractures healed with an average healing time of 10.6 weeks (range, 8-12 weeks). The reduction of articular surface was satisfactory, and the heel height returned to normal. No complication of breakage of internal fixation or traumatic arthritis occurred. The B ouml;hler and Gissane angles were (29.64 ± 5.33)° and (121.75 ± 6.65)°, respectively at 3 months after operation, showing significant differences when compared with the preoperative values (t=43.800, P=0.000; t=33.200, P=0.000). The average time of plate removal was 11.2 months (range, 9-20 months). According to Maryland foot score, the results were excellent in 17 cases, good in 15 cases, and fair in 4 cases; the excellent and good rate was 88.9%. Conclusion The lateral calcaneal U-shaped incision approach is an effective method to treat calcaneal fractures involving the talocalcaneal and calcaneocuboid joints, which can expose the fracture fully, restore the anatomy of the calcaneal bone, and do early exercise under the condition of rigid internal fixation.

Citation： CAO Lihai,PENG Yi,YAN Rongliang,WANG Hongtao.. SURGICAL TREATMENT OF CALCANEAL FRACTURE INVOLVING TALOCALCANEAL AND CALCANEOCUBOID JOINTS. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(2): 169-172. doi: 10.7507/1002-1892.20130038 Copy

1.	Dhillon MS, Bali K, Prabhakar S. Controversies in calcaneus fracture managemet: a systematic review of the literature. Musculoskelet Surg, 2011, 95(3): 171-181.
2.	Zhang JW, Ebraheim N, Lause GE. A comparison of absorbable screws and metallic plates in treating calcaneal fractures: a prospective randomized trial. J Trauma Acute Care Surg, 2012 , 72(2): E106-110.
3.	俞光荣, 燕晓宇. 跟骨骨折治疗方法的选择. 中华骨科杂志, 2006, 26(2): 134-141.
4.	Sanders R, Fortin P, Dipasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
5.	彭光军, 王荣华, 衡德峰, 等. 跟骨骨折不同内固定方法治疗的比较研究. 中国矫形外科杂志, 2010, 18(20): 1686-1688.
6.	Catani F, Benedetti MG, Simoncini L, et al. Analysis of function after intra-articular fracture of the os calcis. Foot Ankle Int, 1999, 20(7): 417-421.
7.	Benirschke SK, Kramer PA. Wound healing complications in closed and open calcaneal fractures. J Orthop Trauma, 2004, 18(1): 1-6.
8.	Kinner BK, Best R, Falk K, et al. Is there a reliable outcome measurement for displaced intra-articular calcaneal fractures? J Trauma, 2002, 53(6): 1094-1102.
9.	Bauer G, Kinzl L. The “low contact plate” for stabilizing the dislocated intra-articular calcaneus fractures. Chirurg, 1996, 67(11): 1129-1134.
10.	Zeman , Zeman J, Matejka J, et al. Long-term results of calcaneal fracture treatment by open reduction and internal fixation using a calcaneal locking compression plat from an extended lateral approach. Acta Chir Traumatol Cech, 2008, 75(6): 457-464.
11.	Al-Mudhaffar M, Prasad CV, Mofidi A. Wound complications following operative fixation of calcaneal fractures. Injury, 2000, 31(6): 461-464.
12.	Maskill JD, Bohay DR, Anderson JG. Calcaneus fractures: a review article. Foot Ankle Clin, 2005, 10(3): 463-489.
13.	文涛, 王力强, 徐希彦. 涉及跟距关节的跟骨骨折手术治疗. 中国修复重建外科杂志, 2010, 24(1): 119-121.
14.	董辉详, 黄长明, 范华强. 钢板内固定治疗SandersⅡ型和Ⅲ型跟骨骨折. 中国实用骨科杂志, 2009, 15(9): 712-713.
15.	田纪青, 焦利斌, 洪勇, 等. 跟骨骨折切开复位内固定早期并发症的预防. 中国骨与关节损伤杂志, 2011, 26(2): 176-177.
16.	唐绪军, 刘树民, 贾古友, 等. 跟骨关节内骨折治疗方法的疗效观察. 中华关节外科杂志(电子版), 2009, 3(1): 10-12.
17.	曹立海, 彭义, 曲家富, 等. 双跟骨骨折的手术治疗及疗效分析. 中国骨与关节损伤杂志, 2011, 26(2): 186-187.
18.	朱勋兵, 孙以术, 林继秀. 预置减张缝合预防跟骨骨折术后切口愈合不良. 中华全科医学, 2008, 6(12): 1232-1233.
19.	Howard JL, Buckley R, McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: aprospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma, 2003, 17(4): 241-249.
20.	王焱, 李公, 潘恒, 等. 软组织评估及干预策略对预防跟骨骨折术后伤口并发症的临床意义. 中华创伤骨科杂志, 2012, 14(8): 659-663.
21.	倪增良, 樊渊, 何建群, 等. 跟骨骨折围手术期的软组织处理. 中国骨与关节损伤杂志, 2011, 26(10): 956-957.
22.	谭小云, 石涛, 徐明元. 跟骨骨折切开复位内固定术后切口并发症分析. 中国修复重建外科杂志, 2009, 23(11): 1407-1408.

1. Dhillon MS, Bali K, Prabhakar S. Controversies in calcaneus fracture managemet: a systematic review of the literature. Musculoskelet Surg, 2011, 95(3): 171-181.
2. Zhang JW, Ebraheim N, Lause GE. A comparison of absorbable screws and metallic plates in treating calcaneal fractures: a prospective randomized trial. J Trauma Acute Care Surg, 2012 , 72(2): E106-110.
3. 俞光荣, 燕晓宇. 跟骨骨折治疗方法的选择. 中华骨科杂志, 2006, 26(2): 134-141.
4. Sanders R, Fortin P, Dipasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290): 87-95.
5. 彭光军, 王荣华, 衡德峰, 等. 跟骨骨折不同内固定方法治疗的比较研究. 中国矫形外科杂志, 2010, 18(20): 1686-1688.
6. Catani F, Benedetti MG, Simoncini L, et al. Analysis of function after intra-articular fracture of the os calcis. Foot Ankle Int, 1999, 20(7): 417-421.
7. Benirschke SK, Kramer PA. Wound healing complications in closed and open calcaneal fractures. J Orthop Trauma, 2004, 18(1): 1-6.
8. Kinner BK, Best R, Falk K, et al. Is there a reliable outcome measurement for displaced intra-articular calcaneal fractures? J Trauma, 2002, 53(6): 1094-1102.
9. Bauer G, Kinzl L. The “low contact plate” for stabilizing the dislocated intra-articular calcaneus fractures. Chirurg, 1996, 67(11): 1129-1134.
10. Zeman , Zeman J, Matejka J, et al. Long-term results of calcaneal fracture treatment by open reduction and internal fixation using a calcaneal locking compression plat from an extended lateral approach. Acta Chir Traumatol Cech, 2008, 75(6): 457-464.
11. Al-Mudhaffar M, Prasad CV, Mofidi A. Wound complications following operative fixation of calcaneal fractures. Injury, 2000, 31(6): 461-464.
12. Maskill JD, Bohay DR, Anderson JG. Calcaneus fractures: a review article. Foot Ankle Clin, 2005, 10(3): 463-489.
13. 文涛, 王力强, 徐希彦. 涉及跟距关节的跟骨骨折手术治疗. 中国修复重建外科杂志, 2010, 24(1): 119-121.
14. 董辉详, 黄长明, 范华强. 钢板内固定治疗SandersⅡ型和Ⅲ型跟骨骨折. 中国实用骨科杂志, 2009, 15(9): 712-713.
15. 田纪青, 焦利斌, 洪勇, 等. 跟骨骨折切开复位内固定早期并发症的预防. 中国骨与关节损伤杂志, 2011, 26(2): 176-177.
16. 唐绪军, 刘树民, 贾古友, 等. 跟骨关节内骨折治疗方法的疗效观察. 中华关节外科杂志(电子版), 2009, 3(1): 10-12.
17. 曹立海, 彭义, 曲家富, 等. 双跟骨骨折的手术治疗及疗效分析. 中国骨与关节损伤杂志, 2011, 26(2): 186-187.
18. 朱勋兵, 孙以术, 林继秀. 预置减张缝合预防跟骨骨折术后切口愈合不良. 中华全科医学, 2008, 6(12): 1232-1233.
19. Howard JL, Buckley R, McCormack R, et al. Complications following management of displaced intra-articular calcaneal fractures: aprospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma, 2003, 17(4): 241-249.
20. 王焱, 李公, 潘恒, 等. 软组织评估及干预策略对预防跟骨骨折术后伤口并发症的临床意义. 中华创伤骨科杂志, 2012, 14(8): 659-663.
21. 倪增良, 樊渊, 何建群, 等. 跟骨骨折围手术期的软组织处理. 中国骨与关节损伤杂志, 2011, 26(10): 956-957.
22. 谭小云, 石涛, 徐明元. 跟骨骨折切开复位内固定术后切口并发症分析. 中国修复重建外科杂志, 2009, 23(11): 1407-1408.

Chinese Journal of Reparative and Reconstructive Surgery

SURGICAL TREATMENT OF CALCANEAL FRACTURE INVOLVING TALOCALCANEAL AND CALCANEOCUBOID JOINTS

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