Lakhey S, Manandhar R R, Pradhan R L, Pandey B K, Sharma S, Rijal K P
Department of Orthopaedics, Kathmandu Medical College, Sinamangal, Nepal.
Kathmandu Univ Med J (KUMJ). 2010 Jan-Mar;8(29):12-7. doi: 10.3126/kumj.v8i1.3215.
The treatment of displaced intra-articular calcaneal fracture is controversial. Conventionally, they were treated non-operatively. However, some surgeons are now operatively treating these fractures because of continuing dissatisfaction with the outcome of conservative treatment of these fractures and improvements that have occurred in surgical techniques and complication rates.
The aim of this study was to determine the functional outcome of operatively treated displaced intra-articular calcaneal fractures using two parallel contoured reconstruction plates.
12 patients with 14 displaced intra-articular calcaneal fractures involving the subtalar joint were included in the study conducted between July 2005 and December 2008. The fracture site was exposed using extended lateral approach. Internal fixation was done by two nearly parallel 3.5mm reconstruction plates and screws contoured to form a gentle curve in all cases with the fi rst plate fixed just below the articular surface. At the end of follow up, the patients' foot function was assessed by Calcaneal Fracture Scoring System of Kerr et al. Patients were also inquired about their satisfaction with their treatment outcome.
The patients were followed up for duration of 12 to 24 months (mean 15.64 months). The outcome score as measured by Calcaneal Fracture Scoring System ranged from 48 to 94 (mean 83.64). 11 of 12 patients (91.6 %) were satisfied with the treatment.
Displaced intra-articular fractures treated by open reduction and internal fixation, using two nearly parallel, contoured reconstruction plates through an extensile lateral approach and following the principles of treatment of intraarticular fractures, have good functional results with high patient satisfaction rate.
移位的关节内跟骨骨折的治疗存在争议。传统上，此类骨折采用非手术治疗。然而，由于对这些骨折保守治疗的结果持续不满意，以及手术技术和并发症发生率的改善，现在一些外科医生对这些骨折进行手术治疗。
本研究的目的是确定使用两个平行的塑形重建钢板手术治疗移位的关节内跟骨骨折的功能结果。
2005年7月至2008年12月进行的这项研究纳入了12例涉及距下关节的14处移位关节内跟骨骨折患者。采用延长外侧入路暴露骨折部位。所有病例均通过两个近乎平行的3.5mm重建钢板和螺钉进行内固定，钢板塑形形成柔和曲线，第一块钢板固定在关节面下方。随访结束时，采用Kerr等人的跟骨骨折评分系统评估患者足部功能。还询问了患者对治疗结果的满意度。
患者随访时间为12至24个月（平均15.64个月）。跟骨骨折评分系统测量的结果评分范围为48至94分（平均83.64分）。12例患者中有11例（91.6%）对治疗满意。
通过切开复位内固定治疗移位的关节内骨折，采用延长外侧入路，使用两个近乎平行的塑形重建钢板，并遵循关节内骨折的治疗原则，具有良好的功能结果和较高的患者满意度。
