Gitajn I Leah, Abousayed Mostafa, Toussaint Rull James, Vrahas Mark, Kwon John Y
Massachusetts General Hospital, Boston, Massachusetts
Massachusetts General Hospital, Boston, Massachusetts.
Foot Ankle Spec. 2015 Feb;8(1):10-7. doi: 10.1177/1938640014548323. Epub 2014 Sep 8.
The purpose of this study was to evaluate prognostic predictors of complications and need for secondary surgery in a series of calcaneal avulsion fractures.
Thirty-three patients who sustained extra-articular calcaneal avulsion fractures from 2002 to 2011 were retrospectively identified. Main outcome measurement was need for secondary surgical procedures. Secondary complications such as soft tissue complications and loss of fixation were noted. Prognostic factors for outcome measures were identified.
There was a need for secondary operations in 12 cases. Of those, 10 (83%) had wound complications and 5 (41.7%) had failure of fixation. Two subjects required below knee amputation. Of the entire cohort of 33 patients, 13 (39.4%) had soft tissue complications. Of the 22 that underwent surgery, 6 (27%) had failure of fixation. Increased age was significantly associated with wound complications (P = .029). Hypothyroidism (P = .003), peripheral vascular disease (P = .022), and presence of more than one comorbidity (P = .005) were significantly associated with need for secondary surgical intervention. Skin compromise at presentation was significantly associated with soft tissue complication (P = .036) and failure of fixation (P = .046).
Calcaneal avulsion fractures have a high incidence of soft tissue problems, failure of fixation, and need for additional surgeries. Comorbid conditions and increased age portend a poor prognosis with a significant association with wound complications and need for additional surgeries.
Prognostic, Level II: Retrospective Analysis.
本研究旨在评估一系列跟骨撕脱骨折并发症及二次手术需求的预后预测因素。
回顾性纳入2002年至2011年发生关节外跟骨撕脱骨折的33例患者。主要观察指标为二次手术需求。记录软组织并发症和内固定失败等二次并发症。确定预后指标的预后因素。
12例需要二次手术。其中，10例（83%）发生伤口并发症，5例（41.7%）发生内固定失败。2例患者需要行膝下截肢术。在33例患者的整个队列中，13例（39.4%）发生软组织并发症。在接受手术的22例患者中，6例（27%）发生内固定失败。年龄增加与伤口并发症显著相关（P = .029）。甲状腺功能减退（P = .003）、外周血管疾病（P = .022）以及存在一种以上合并症（P = .005）与二次手术干预需求显著相关。就诊时皮肤损伤与软组织并发症（P = .036）和内固定失败（P = .046）显著相关。
跟骨撕脱骨折软组织问题、内固定失败及再次手术需求的发生率较高。合并症和年龄增加预示预后不良，与伤口并发症及再次手术需求显著相关。
预后性，二级：回顾性分析。
