Department of Orthopaedic Surgery, Siloah Hospital, Gümligen/Bern, Switzerland.
Department of Orthopaedic Surgery, Inselspital, University of Bern, Bern, Switzerland.
Foot Ankle Int. 2020 Jan;41(1):57-62. doi: 10.1177/1071100719873273. Epub 2019 Sep 3.
The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique.
Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months).
The mean AOFAS score was 87 ± 13 (range, 32-100). "Excellent" and "good" results, as well as hindfoot motion with "normal/mild" and "moderate" restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%).
The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal.
Level IV, retrospective case series.
移位型关节内跟骨骨折的治疗仍然是一个挑战，最佳治疗方法仍存在争议。避免采用广泛的外侧入路的主要原因是由于伤口愈合问题导致的高并发症发生率。我们报告了 16 年采用标准化有限切开复位内固定技术的经验。
在 2001 年至 2017 年期间，我们前瞻性地随访了 240 例连续接受手术治疗的移位型关节内跟骨骨折患者。排除开放性、多发性、双侧性、关节外和 Sanders Ⅳ型骨折患者，以及失访患者。采用外侧跗骨下入路，使用石膏固定 8 周，12 周后允许完全负重。随访检查计划持续到 24 个月。主观和临床评估包括步态异常、距下关节和踝关节活动度以及稳定性和对线。计算美国矫形足踝协会（AOFAS）后足评分。在标准 X 线片上分析对线情况。共有 131 例患者被排除。其余 109 例患者至少随访 24 个月（34.4±14.2[范围，24-102]个月）。
平均 AOFAS 评分为 87±13（范围，32-100）。80%的患者结果为“优秀”和“良好”，后足运动为“正常/轻度”和“中度”受限。2 例患者因复位不足行早期再次手术，3 例患者因伤口愈合延迟行清创术，1 例患者因血肿行清创术。3 例患者行关节融合术，1 例患者行内侧跟骨截骨术，53 例患者（49%）行内固定取出术。
该方法 16 年来保持不变，功能结果始终良好。主要缺点是跟骨螺钉取出率高。
IV 级，回顾性病例系列研究。
