Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
Int Orthop. 2013 Sep;37(9):1833-8. doi: 10.1007/s00264-013-2065-4.
Locked fracture-dislocations of the calcaneus are uncommon, and a substantial number of these injuries is not recognised or is misdiagnosed at first presentation. The primary aim of this study was to evaluate the long-term outcome in patients with this injury.
This is a retrospective cohort study of adult patients who sustained a uni- or bilateral calcaneal fracturedislocation. Outcome was measured using validated questionnaires, including the American Orthopaedic Foot and Ankle Society Hindfoot score (AOFAS), Foot Function Index (FFI) and a visual analogue scale (VAS).
During the 12-year study period a total of 16 patients with 17 locked fracture-dislocations were identified. This represented 6 % of all surgically treated calcaneal fractures (17 of 279). The median follow-up was 48 months. All patients were treated using an extended lateral approach and plate fixation. In one patient with a delayed presentation a primary arthrodesis was performed. The functional outcome scores were available for 14 patients with 14 fractures. The median AOFAS was 74 [interquartile range (IQR) 47–86], the median FFI was 18 (IQR 6–37) and the median VAS for overall satisfactionwas 8.2 (IQR 5.5–9.4). A secondary fusion was deemed necessary in three cases.
This study shows that, with surgical treatment via an extended lateral approach, the outcome in patients with a locked fracture-dislocation of the calcaneus is similar to the outcome of other displaced intra-articular calcaneal fracture types. However, a higher rate of secondary subtalar fusion can be expected.
跟骨骨折-脱位较为少见，其中相当一部分在初次就诊时未被识别或误诊。本研究的主要目的是评估此类损伤患者的长期预后。
这是一项回顾性队列研究，纳入了成人单侧或双侧跟骨骨折-脱位患者。采用美国矫形足踝协会后足评分（AOFAS）、足功能指数（FFI）和视觉模拟评分（VAS）等有效问卷评估预后。
在 12 年的研究期间，共发现 16 例 17 处锁定骨折-脱位患者。这占所有手术治疗的跟骨骨折的 6%（279 例中的 17 例）。中位随访时间为 48 个月。所有患者均采用延长外侧入路和钢板固定治疗。1 例延迟就诊的患者行一期关节融合术。14 例 14 处骨折的功能评分结果可用。AOFAS 中位数为 74（四分位距 4786），FFI 中位数为 18（四分位距 637），总体满意度 VAS 中位数为 8.2（四分位距 5.5~9.4）。有 3 例需要行二期融合术。
本研究表明，通过延长外侧入路的手术治疗，锁定跟骨骨折-脱位患者的预后与其他关节内移位跟骨骨折类型相似。但预计会有更高的继发距下融合率。
