Lui T H
Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong Special Administrative Region, China.
Foot Ankle Surg. 2018 Feb;24(1):45-48. doi: 10.1016/j.fas.2016.11.006. Epub 2016 Nov 17.
To review the efficacy of lag screw fixation in management of avulsion fracture of the posterosuperior tuberosity of the calcaneus.
Since 2002, thirteen patients with displaced fracture of the posterior tuberosity of the calcaneus were treated with emergency reduction of the fracture and lag screw fixation. The medical records and radiographs of the patients were reviewed and the patients were assessed according to the Kerr calcaneal fracture scoring system during the latest follow up.
There was no skin necrosis, but one wound dehisced in a patient with unstable diabetes and hypothyroidism. All fractures healed, but two had separation of the fracture fragments after the plaster was removed, both of them were elderly osteoporotic patients. The overall average calcaneal score was 93 (range, 77-100). The average calcaneal score of the patients with closed reduction was 91 (range, 77-100). The average calcaneal score of the patients with open reduction was 94 (range, 79-100). Complications occurred in seven patients (54%).
Percutaneous or open reduction of the avulsion fracture of the posterosuperior tuberosity of the calcaneus together with lag screw fixation and equinus short leg cast immobilization can provide good results without skin necrosis. The surgeon should pay attention of the details of the operation and the rehabilitation program in order to minimize the complications.
回顾拉力螺钉固定治疗跟骨后上结节撕脱骨折的疗效。
自2002年以来，13例跟骨后结节移位骨折患者接受了骨折急诊复位及拉力螺钉固定治疗。回顾患者的病历和X线片，并在最近一次随访时根据克尔跟骨骨折评分系统对患者进行评估。
未出现皮肤坏死，但1例患有不稳定型糖尿病和甲状腺功能减退症的患者伤口裂开。所有骨折均愈合，但2例在拆除石膏后出现骨折块分离，均为老年骨质疏松患者。跟骨总体平均评分为93分（范围77 - 100分）。闭合复位患者的平均跟骨评分为91分（范围77 - 100分）。切开复位患者的平均跟骨评分为94分（范围79 - 100分）。7例患者（54%）出现并发症。
跟骨后上结节撕脱骨折采用经皮或切开复位，联合拉力螺钉固定及马蹄形短腿石膏固定，可取得良好效果且无皮肤坏死。外科医生应注意手术细节和康复计划，以尽量减少并发症。
