Carnero-Martín de Soto Pablo, Bautista-Enrique David, Gómez-Cáceres Abel, Rodríguez-León Alfredo, Bravo-Zurita María José, Santos-Maraver María Teresa
Surgeon, Department of Traumatology and Orthopedic Surgery, Hospital Regional Universitario de Málaga, Málaga, Spain; Surgeon, Arthrosport Zaragoza, Clínica El Pilar, Zaragoza, Spain.
Surgeon, Department of Traumatology and Orthopedic Surgery, Hospital Regional Universitario de Málaga, Málaga, Spain.
J Foot Ankle Surg. 2019 May;58(3):423-426. doi: 10.1053/j.jfas.2018.09.002. Epub 2019 Feb 8.
Avulsion fractures of the posterior calcaneal tuberosity are rare injuries, and little is known about the underlying factors, outcomes, and prognosis. Furthermore, classifications described previously focus on fracture morphology, with uncertain clinical utility. We present the results of a retrospective study of 21 patients treated for this pathology from January 2002 to December 2015. Features analyzed were age; sex; mechanism of injury; medical comorbidities; type of fracture, as proposed by Beavis; fracture displacement; fragment size; type of treatment; complications; need for secondary surgery; and the American Orthopaedic Foot and Ankle Society score after treatment and follow-up care. Mean age was 56.95years. A total of 61.9% were females, and 71.4% were secondary to low-energy trauma. In addition, 19% were diabetic. Mean follow-up was 57.24 months. Surgery was performed in 81%. Complications rate was 61.9%, and secondary surgery was needed in 38.1%. Mean fracture displacement was significantly higher when complications occurred (25.91mm versus 7.61 mm) (p = .03) and when soft tissues complications appeared (30.65mm versus 14.68 mm) (p = .02). Female gender was associated with the secondary loss of reduction (p = .04). The Beavis classification was not related significantly with any outcome variable. When fracture displacement was ≥2cm, complication rate increased from 30% to 90.9% (p = .008) and soft tissue compromise increased from 0% to 45.45% (p = .035). A new classification system with prognostic value is described, based on fracture displacement. We present 1 of the largest series published to date; fracture displacement is a major variable that influences the outcomes of these injuries, and a new classification attending to a prognostic factor is developed.
跟骨后结节撕脱骨折是一种罕见的损伤，对于其潜在因素、治疗结果及预后了解甚少。此外，先前描述的分类方法侧重于骨折形态，其临床实用性尚不确定。我们对2002年1月至2015年12月间接受该疾病治疗的21例患者进行了一项回顾性研究。分析的特征包括年龄、性别、损伤机制、内科合并症、Beavis提出的骨折类型、骨折移位、碎骨片大小、治疗方式、并发症、二次手术需求以及治疗和随访后的美国矫形足踝协会评分。平均年龄为56.95岁。女性占61.9%，71.4%的损伤继发于低能量创伤。此外，19%的患者患有糖尿病。平均随访时间为57.24个月。81%的患者接受了手术治疗。并发症发生率为61.9%，38.1%的患者需要二次手术。发生并发症时平均骨折移位明显更高（25.91mm对7.61mm）（p = 0.03），出现软组织并发症时平均骨折移位也明显更高（30.65mm对14.68mm）（p = 0.02）。女性与复位的二次丢失相关（p = 0.04）。Beavis分类与任何结果变量均无显著相关性。当骨折移位≥2cm时，并发症发生率从30%增至90.9%（p = 0.008），软组织损伤从0%增至45.45%（p = 0.035）。基于骨折移位描述了一种具有预后价值的新分类系统。我们展示了迄今为止发表的最大系列研究之一；骨折移位是影响这些损伤治疗结果的主要变量，并开发了一种考虑预后因素的新分类方法。
