Aslan Ahmet, Sargın Serdar, Gülcü Anıl, Konya Mehmet Nuri
Department of Orthopedics and Traumatology, Alanya Alaaddin Keykubat University, Faculty of Medicine, 07425 Alanya, Antalya, Turkey.
Eklem Hastalik Cerrahisi. 2019 Aug;30(2):143-8. doi: 10.5606/ehc.2019.66447.
This study aims to compare the radiological, clinical and patient-reported outcomes of patients with intra-articular calcaneus fractures treated conservatively or surgically.
Fifty-four patients (30 males, 24 females; mean age 41.0 years; range, 18 to 73 years) treated due to calcaneus fracture were included in the study. Twenty-nine patients underwent conservative treatment (group 1) and 25 patients underwent surgical treatment (group 2). The fractures were classified according to Sanders. At the final follow-up, patients' Bohler's angle, The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Foot Function Index (FFI) were used to evaluate their radiological, clinical and patient-reported outcomes. Postoperative complications were also noted.
The fracture was at the right foot in 28 patients and the left foot in 26 patients. The mean follow-up duration was 41.1±23.2 months (range, 24 to 126 months). No statistically significant differences were found between the groups in terms of gender, fracture side, mean age, or follow-up duration (p=0.951, p=0.571, p=0.326, and p=0.620, respectively). According to Sanders classification, 18 patients were type 2 and 11 patients were type 3 in group 1, while 11 patients were type 2 and 14 patients were type 3 in group 2. However, there was no statistically significant difference between the groups in terms of the type of the fracture (p=0.184). On the other hand, the outcomes were significantly better for group 2 compared to group 1 in terms of the Bohler's angle, AOFAS and FFI scores (p=0.004, p=0.003 and p=0.006, respectively). In group 1, subtalar arthritis developed in three patients. In group 2, wound healing problems and superficial infection developed in three patients, while subtalar arthritis developed in two patients.
Surgical treatment is more effective in intra-articular calcaneus fractures compared to conservative treatment according to clinical, radiological and patient-reported outcomes. In addition, wound problems should be considered in surgical management.
本研究旨在比较保守治疗或手术治疗的关节内跟骨骨折患者的影像学、临床及患者报告的结局。
本研究纳入了54例因跟骨骨折接受治疗的患者（30例男性，24例女性；平均年龄41.0岁；范围18至73岁）。29例患者接受保守治疗（第1组），25例患者接受手术治疗（第2组）。骨折根据Sanders分类法进行分类。在末次随访时，采用患者的Bohler角、美国矫形足踝协会（AOFAS）踝-后足评分和足部功能指数（FFI）来评估其影像学、临床及患者报告的结局。同时记录术后并发症。
28例患者骨折位于右脚，26例患者骨折位于左脚。平均随访时间为41.1±23.2个月（范围24至126个月）。两组在性别、骨折侧、平均年龄或随访时间方面均未发现统计学显著差异（分别为p = 0.951、p = 0.571、p = 0.326和p = 0.620）。根据Sanders分类，第1组18例患者为2型，11例患者为3型；第2组11例患者为2型，14例患者为3型。然而，两组在骨折类型方面未发现统计学显著差异（p = 0.184）。另一方面，在Bohler角、AOFAS和FFI评分方面，第2组的结局明显优于第1组（分别为p = 0.004、p = 0.003和p = 0.006）。第1组有3例患者发生距下关节炎。第2组有3例患者出现伤口愈合问题和浅表感染，2例患者发生距下关节炎。
根据临床、影像学及患者报告的结局，手术治疗关节内跟骨骨折比保守治疗更有效。此外，手术治疗时应考虑伤口问题。
