Emara Khaled Mohamed, Allam Mohamed Farouk
Department of Orthopaedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
Clin Orthop Relat Res. 2005 Oct;439:215-20. doi: 10.1097/00003086-200510000-00037.
Treating calcaneal fractures nonoperatively versus operatively is controversial. The aim of open reduction is to reduce the articular surface and to restore the calcaneal bone anatomy to recover its function. The disadvantages of open reduction include wound complications, risk of screw penetration of the articular surface and peroneal tendons, and irritation by the fixation plate. We treated 12 patients with Sanders Type 3 calcaneal fractures with poor skin condition persisting for more than 3 weeks, making them unsuitable candidates for typical open reduction and internal fixation. The 12 patients had open reduction of the articular surface of the subtalar and calcaneocuboid joints, then a bone graft using a direct approach to the subtalar joint. The fracture reduction was completed by fixing the calcaneal tuberosity with an Ilizarov external fixation frame and distraction. These outcomes of these 12 patients were compared with outcomes of a control group having the same type of fracture but treated with open reduction and internal fixation. We used the American Orthopaedic Foot and Ankle Society scoring system to assess the outcome. Both groups had similar functional and radiographic outcomes. The internal fixation group had a higher complication rate. The Ilizarov apparatus for reduction and fixation seems to be a safe and effective alternative to open reduction and internal fixation in patients with poor skin condition.
跟骨骨折的非手术治疗与手术治疗存在争议。切开复位的目的是恢复关节面并恢复跟骨的解剖结构以恢复其功能。切开复位的缺点包括伤口并发症、螺钉穿入关节面和腓骨肌腱的风险以及固定板的刺激。我们治疗了12例Sanders 3型跟骨骨折患者，这些患者皮肤状况较差且持续超过3周，使其不适合进行典型的切开复位内固定。这12例患者对距下关节和跟骰关节的关节面进行了切开复位，然后采用直接入路至距下关节进行植骨。通过使用Ilizarov外固定架固定跟骨结节并进行牵引来完成骨折复位。将这12例患者的结果与具有相同类型骨折但接受切开复位内固定治疗的对照组的结果进行比较。我们使用美国矫形足踝协会评分系统来评估结果。两组在功能和影像学结果方面相似。内固定组的并发症发生率更高。对于皮肤状况较差的患者，Ilizarov复位固定装置似乎是切开复位内固定的一种安全有效的替代方法。
