ObjectiveTo discuss the effectiveness of limited open reduction via sinus tarsi approach using medial distraction technique in the treatment of intra-articular calcaneus fractures by comparing with open reduction and internal fixation via extensile L-shaped incision. MethodsA retrospective analysis was made on the clinical data of 21 patients with intra-articular calcaneus fractures treated by sinus tarsi approach combined with medial distraction technique between April 2013 and November 2014 (minimally invasive group), and 32 patients treated by extensile L-shaped incision approach between June 2012 and September 2014 (extensile incision group). No significant difference was found in gender, age, injury pattern, fracture classification, time from injury to operation, preoperative Böhler angle, Gissane angle, calcaneal varus angle, the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and visual analogue scale (VAS) score between 2 groups (P>0.05), which was comparable. The operation time, wound complications, and bone healing time were recorded. The postoperative function was also evaluated by AOFAS score and VAS score. The pre-and post-operative Böhler angle, Gissane angle, and calcaneal varus angle were measured on the X-ray films, and the corrective angle was calculated. ResultsSixteen patients were followed up 6-18 months (mean, 11.5 months) in the minimally invasive group, and 23 patients for 6-24 months (mean, 13.5 months) in the extensile incision group. Difference was not significant in operation time between 2 groups (t=0.929, P=0.796). No complication occurred in the minimally invasive group; partial skin flap necrosis occurred in 3 cases of the extensile incision group, was cured after dressing change. There was no loosening of implants or reduction loss in 2 groups at last follow-up. Subtalar joint stiffness occurred in 1 case of the minimally invasive group and 4 cases of the extensile incision group, and 1 patient had discomfort for the implants in the extensile incision group. The bone healing time was (9.9±0.8) weeks in the minimally invasive group, and was (10.1±0.7) weeks in the extensile incision group, showing no significant difference (t=0.613, P=0.845). Böhler angle, Gissane angle, calcaneal varus angle, AOFAS score, and VAS score were significantly improved at last follow-up when compared with preoperative values in 2 groups (P < 0.05), but there was no significant difference between 2 groups (P>0.05), and the corrective value of angle showed no significant difference between 2 groups (P>0.05). ConclusionLimited open reduction via sinus tarsi approach for intra-articular calcaneus fractures could reduce the incidence of wound complications effectively. Meanwhile, the medial distraction technique is helpful to correct the heel varus deformity.
ObjectiveTo explore the effectiveness and operative methods to treat first metatarsal diaphysis comminuted fractures with mini-plate via medial approach. MethodsBetween January 2012 and January 2013, 15 patients with first metatarsal shaft comminuted fractures were treated. There were 11 males and 4 females (6 left feet and 9 right feet) with an average age of 38.6 years (range, 27-56 years). The injury causes included falling injury in 6 cases, crash injury of heavy object in 7 cases, and sprain in 2 cases. The left side was involved in 6 cases and the right side in 9 cases. The time from injury to operation was 8.5 days on average (range, 7-10 days). According to AO classification, all cases were rated as 81(T)-C2 type. The surgical treatments included open reduction and internal fixation with mini-plate by medial approach. ResultsPrimary healing of incision was obtained in all cases, and no infection occurred. Twelve patients were followed up 18 months on average (range, 12-24 months). All fractures healed well, and the mean time of bone union was 11.5 weeks (range, 10-14 weeks). No loosening or breakage of internal fixation was observed. At last follow-up, the patients could walk with full weight-bearing, and had no pain. According to American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale, the mean score was 85.2 (range, 76-96). ConclusionAnatomic reduction and stable internal fixation are important for first metatarsal comminuted fracture, which is the key point for recovery of foot form and foot arch function. And the medial approach could achieve full exposure and improve the cosmetic results.