Besch Lutz, Waldschmidt Jan Soeren, Daniels-Wredenhagen Mark, Varoga Deike, Mueller Michael, Hilgert Ralf-Erik, Mathiak Guenther, Oestern Stefanie, Lippross Sebastian, Seekamp Andreas
Department of Traumatology, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
J Foot Ankle Surg. 2010 Jan-Feb;49(1):8-15. doi: 10.1053/j.jfas.2009.07.019.
We developed a hinged external fixator for the treatment of dislocated intra-articular calcaneus fractures with severe soft tissue damage. The external fixation was performed with a known external fixator system. The screw insertion points were biomechanically tested by defining a virtual rotation axis through the center of the talus to allow early active motion in the ankle joint. Long-term follow-up was performed after an average of 7.3 years. Results were graded with the American Orthopaedic Foot and Ankle Society (AOFAS) score. Radiographs were reviewed according to Sanders classification. Four open fractures and 33 cases with extremely swollen soft tissue, blisters, or compartment syndromes were treated. In 24 cases (64.9%), the hinged fixator was the final method of treatment (group I). A change to open reduction with internal fixation was performed in 13 fractures (35.1%) when soft tissue problems were minimal (group II). There were no late amputations, osteomyelitis, or malunions. According to Sanders classification, group I consisted of 14 type II, 8 type III, and 2 type IV fractures. Pin loosening or pin infection was seen in 4 cases, but there was no redislocation. The Böhler's angle improved in 43%, gaps in the posterior facet were closed in 41%, and any shortening or deviation of the axis was corrected in 82% of the cases. The AOFAS score for the group averaged 66.5. According to Sanders classification, group II consisted of 8 type II and 5 type III fractures. The Böhler's angle improved in 88%, and gaps in the posterior facet were closed in 87%. Any shortening or deviation of the axis was corrected in 95%, and the AOFAS score averaged 61.3. Significant differences in patient outcome scores between open reduction with internal fixation and hinged fixator were not found. P value was > .05. The hinged external fixator frame can be used in all calcaneus fracture types without soft tissue limitation. The hinged fixator allows early movement in the ankle joint, the risk of infection is minimized, and secondary plate fixation remains possible.
我们研发了一种铰链式外固定器，用于治疗伴有严重软组织损伤的关节内跟骨骨折脱位。外固定采用已知的外固定器系统进行。通过定义一条穿过距骨中心的虚拟旋转轴，对螺钉插入点进行生物力学测试，以允许踝关节早期主动活动。平均7.3年后进行长期随访。结果采用美国矫形足踝协会（AOFAS）评分进行分级。根据Sanders分类法对X线片进行评估。共治疗了4例开放性骨折以及33例软组织极度肿胀、出现水泡或骨筋膜室综合征的病例。24例（64.9%）中，铰链式固定器是最终治疗方法（I组）。13例骨折（35.1%）在软组织问题最小时改为切开复位内固定（II组）。未出现晚期截肢、骨髓炎或骨不连情况。根据Sanders分类，I组包括14例II型、8例III型和2例IV型骨折。4例出现钢针松动或钢针感染，但未出现再脱位。43%的病例跟骨结节角得到改善，41%的病例后关节面间隙闭合，82%的病例轴线的任何缩短或偏移得到纠正。该组AOFAS评分平均为66.5。根据Sanders分类，II组包括8例II型和5例III型骨折。88%的病例跟骨结节角得到改善，87%的病例后关节面间隙闭合。95%的病例轴线的任何缩短或偏移得到纠正，AOFAS评分平均为61.3。切开复位内固定与铰链式固定器在患者预后评分方面未发现显著差异。P值>0.05。铰链式外固定器框架可用于所有类型的跟骨骨折，不受软组织条件限制。铰链式固定器允许踝关节早期活动，感染风险降至最低，且仍可进行二期钢板固定。
