Summers Hobie, Ann Kramer Patricia, Benirschke Stephen K
Department of Orthopaedics and Sports Medicine, Harborview Medical Center, University of Washington, Seattle, WA, USA.
Orthop Rev (Pavia). 2009 Jun 30;1(1):e9. doi: 10.4081/or.2009.e9.
Although operative treatment of displaced, intra-articular fractures of the calcaneus in adults is generally accepted as standard practice, operative treatment for the same fractures in the skeletally immature remains controversial, potentially because the outcome for fracture types (intra- vs. extra-articular) and severity (displaced vs. nondisplaced) have been confounded in studies of children. We review herein the results of 21 displaced, intra-articular fractures in 18 skeletally immature patients, who were treated with open reduction and internal fixation using a standard surgical approach and protocol developed for adults. The average pre-operative Böhler's angle on the injured side was -5° (range: -35 - +35) compared to 31° (range: +22 - +47) on the uninjured side, indicating substantial displacement. There were no post-operative infections or wound healing problems, and all but one patient was followed to union (average follow-up: 1.5 years; range: 0.30-4.3 years). Maintenance of reduction was confirmed on follow-up radiographs with an average Böhler's angle of 31° (range: +22 - +49). We demonstrate that results for operative fixation of displaced, intra-articular calcaneal fractures in the skeletally immature are comparable to those in adults when the treatment protocol is the same.
尽管成人跟骨关节内移位骨折的手术治疗通常被视为标准做法，但骨骼未成熟患者的相同骨折手术治疗仍存在争议，这可能是因为在儿童研究中骨折类型（关节内与关节外）和严重程度（移位与未移位）的结果相互混淆。我们在此回顾了18例骨骼未成熟患者的21例移位关节内骨折的治疗结果，这些患者采用为成人制定的标准手术方法和方案进行切开复位内固定。患侧术前平均Böhler角为-5°（范围：-35°至+35°），而健侧为31°（范围：+22°至+47°），表明存在明显移位。术后无感染或伤口愈合问题，除1例患者外，所有患者均随访至骨折愈合（平均随访1.5年；范围：0.30至4.3年）。随访X线片证实复位得以维持，平均Böhler角为31°（范围：+22°至+49°）。我们证明，当治疗方案相同时，骨骼未成熟患者移位关节内跟骨骨折的手术固定结果与成人相当。
