[Case-control study on therapeutic effects between Kirschner wire fixation after early bebridement and staged plate fixation in the treatment of open calcaneal fractures].

OBJECTIVE

To compare therapeutic effects between Kirschner wire fixation after early debridement (Kirschner wire group) and staged plate fixation (plate group) in the treatment of open calcaneal fractures.

METHODS

From January 2001 to May 2008, 55 patients (58 feet) with open calcaneal fractures were reviewed,the mean age was 36.8 years(ranged, 19 to 65 years) and the average visit time was 3 hours (ranged, 30 min to 7 h). All the patients were divided into two groups: Kirschner wire group and plate group. There were 20 males (20 feet) and 9 females (9 feet) in Kirschner wire group, in which 15 feet were type I, 13 feet were type II, 1 foot was type III A according to Gustilo classification and 9 feet were type II, 18 feet were type III, 2 feet were type IV according to Sanders classification. The patients in Kirschner wire group were treated with early debridement, fracture reduction and Kirschner wire fixation, and the soft tissue defects were covered with VSD temporarily, and then were enveloped by skin or flap grafts at the second stage. There were 18 males (19 feet) and 8 females (10 feet) in the plate group, in which 13 feet were type I, 14 feet were type II, 2 feet were type III A according to Gustilo classification and 11 feet were type II,15 feet were type III, 3 feet were type IV according to Sanders classification. The patients in the plate group were treated with early debridement, and plate internal fixation with were performed when the wound became stabilization.

RESULTS

Twenty-three feet (15 patients) in the Kirschner wire group and 22 feet (13 patients) in the plate group were followed, the duration ranged from 10 to 36 months, with an average of 24 months. Compared with preoperative ones, the heel height, width, Böhler angle and Gissane angle of calcaneal got improvements. According to AOFAS ankle-foot evaluation system, 11 feet got an excellent result, 8 good in the Kirschner wire group; 2 feet had wound local skin necrosis and cured by dressing; 1 foot had a large area of skin necrosis and deep infection; 1 foot had chronic osteomyelitis. All above 4 feet underwent arthrodesis later. As comparison, 7 feet got an excellent result, 4 good in the plate group; 2 patients had mild complications of wounds; 1 patient had chronic osteomyelitis after early debridement; 10 patients had wound complications after internal fixation, including 7 patients with skin necrosis, superficial infection in 3 patients. There were statistical significant in radiological indicators and AOFAS ankle-foot scores between two groups. But there were no significant differences in early postoperative complications between the two groups.

CONCLUSION

Early debridement and Kirschner wire fixation for the treatment of open calcaneal fractures has fewer early complications, which is a simple, safe and effective method.