Department of Orthopaedics and Rehabilitation, San Antonio Military Medical Center, Fort Sam Houston, TX, USA.
J Orthop Trauma. 2012 Nov;26(11):662-70. doi: 10.1097/BOT.0b013e31824a3f1f.
To determine the clinical and functional outcomes of high-grade (types II and III) open calcaneus fractures managed with a protocol of modern wound care, open reduction via the medial hindfoot wound, and percutaneous screw fixation.
Retrospective clinical series of consecutively treated patients.
Regional trauma center (level 2).
PATIENTS/PARTICIPANTS: Seventeen consecutive patients with open type II and III calcaneus fractures treated with fracture repair by a single surgeon.
Soft tissue debridement and modern wound care, reduction of calcaneus fractures through the open medial wound, and percutaneous screw fixation.
Patient demographics and injury data, radiographic analyses, complications of treatment, and hindfoot outcomes assessed with American Orthopaedic Foot and Ankle Surgeon and Maryland Foot Scores and general health with the Short Form 36 measurement at a minimum of 12 months post injury.
Seventeen patients were available for follow-up at >12 months, with 15 completing all outcome measures. Four fractures were graded as type II, 9 as type IIIA, and 4 as type IIIB. There was 1 deep infection, and 1 wound dehiscence, both in type III open injuries; both were successfully treated with local wound care, delayed closure, and appropriate antibiotics. Overall, 7 of 17 (41%) patients required secondary surgical procedures, including 4 hindfoot fusions (23.5%). The average American Orthopaedic Foot and Ankle Surgeon score was 77 (range, 32-95), and the Maryland Foot Score was 64 (range, 16-93). The physical and mental components of the Short Form 36 averaged 44.4 and 49.1, respectively.
Limb-threatening catastrophic complications are uncommon for high-grade open calcaneus fractures treated with modern soft-tissue care, fracture reduction using the medial open fracture wound, and percutaneously placed screw fixation. Limb and whole body functional outcomes are comparable to previously published reports of both closed and open calcaneus fractures.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
确定采用现代伤口护理、经内侧后足伤口切开复位和经皮螺钉固定治疗的高等级（II 型和 III 型）开放性跟骨骨折的临床和功能结果。
连续治疗患者的回顾性临床系列。
区域创伤中心（二级）。
患者/参与者：由一位外科医生治疗的 17 例连续开放性 II 型和 III 型跟骨骨折患者。
软组织清创和现代伤口护理，通过开放性内侧伤口复位跟骨骨折，经皮螺钉固定。
患者人口统计学和损伤数据、影像学分析、治疗并发症以及美国矫形足踝外科医师协会和马里兰足部评分评估的后足结果，以及至少 12 个月后用简短表格 36 测量的一般健康状况。
17 例患者在 >12 个月时可进行随访，其中 15 例完成了所有的结果测量。4 例骨折为 II 型，9 例为 IIIA 型，4 例为 IIIB 型。有 1 例深部感染，1 例伤口裂开，均为 III 型开放性损伤；两者均通过局部伤口护理、延迟闭合和适当的抗生素成功治疗。总体而言，17 例患者中有 7 例（41%）需要二次手术，包括 4 例后足融合术（23.5%）。美国矫形足踝外科医师协会评分平均为 77（范围 32-95），马里兰足部评分平均为 64（范围 16-93）。简短表格 36 的身体和心理成分平均值分别为 44.4 和 49.1。
采用现代软组织治疗、经内侧开放骨折伤口复位和经皮螺钉固定治疗高等级开放性跟骨骨折，肢体威胁性灾难性并发症并不常见。肢体和全身功能结果与已发表的闭合和开放性跟骨骨折报告相当。
治疗水平 IV。有关证据水平的完整描述，请参阅作者说明。
