Resident, Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, MA.
Surgeon, Department of Orthopaedic Surgery, Harvard Medical School Orthopedic Trauma Initiative, Massachusetts General Hospital, Boston, MA.
J Foot Ankle Surg. 2020 Mar-Apr;59(2):264-268. doi: 10.1053/j.jfas.2019.02.006.
Because consensus on the optimal surgical treatment of tongue-type calcaneal fractures is lacking, this study aimed to compare outcomes and postoperative complications of open and closed surgical treatment of these fractures. For this cases series, all patients 18 years or older who underwent operative fixation of tongue-type calcaneal fractures at 2 level I trauma centers between 2004 and 2015 were considered eligible for participation. Data on explanatory and outcome variables were collected from medical records based on available follow-up. Additionally, a systematic literature review on surgical treatment of these fractures was conducted. Fifty-six patients (58 tongue-type fractures) were included. Open reduction internal fixation was performed in 33 fractures, and closed reduction internal (percutaneous) fixation was performed in 25. More wound problems and deep infections were observed with open treatment compared with the closed approach: 10 (30%) versus 3 (12%) and 4 (12%) versus 0 (0%) procedures, respectively. In contrast, revision and hardware removal predominated in patients with closed treatments: 4 (16%) versus 1 (3%) and 9 (36%) versus 8 (24%) procedures, respectively. The systematic literature review yielded 10 articles reporting on surgical treatment for tongue-type fractures, all showing relatively good outcomes and low complication rates with no definite advantage for either technique. Both open and closed techniques are suggested as accurate surgical treatment options for tongue-type calcaneal fractures. Surgical treatment should be individualized, considering both fracture and patient characteristics and the treating surgeon's expertise. We recommend attempting closed reduction internal fixation if deemed feasible, with conversion to an open procedure if satisfactory reduction or fixation is unobtainable.
由于对于跟骨舌型骨折的最佳手术治疗方法尚未达成共识，本研究旨在比较切开和闭合手术治疗这些骨折的结果和术后并发症。本病例系列研究纳入了 2004 年至 2015 年期间在 2 个一级创伤中心接受手术固定跟骨舌型骨折的所有 18 岁及以上患者。根据随访情况，从病历中收集了说明性和结局变量的数据。此外，还对这些骨折的手术治疗进行了系统的文献回顾。共纳入 56 例患者（58 例跟骨舌型骨折）。其中 33 例采用切开复位内固定，25 例采用闭合复位内固定（经皮）。与闭合治疗相比，切开治疗的伤口问题和深部感染更多：10 例（30%）比 3 例（12%）和 4 例（12%）比 0 例（0%）。相比之下，闭合治疗中更多地需要进行翻修和去除内固定物：4 例（16%）比 1 例（3%）和 9 例（36%）比 8 例（24%）。系统的文献回顾共纳入 10 篇关于手术治疗跟骨舌型骨折的文章，均显示出相对较好的结果和较低的并发症发生率，两种技术均无明显优势。切开和闭合技术均被认为是治疗跟骨舌型骨折的准确手术治疗选择。手术治疗应个体化，既要考虑骨折和患者的特点，也要考虑手术医生的专业水平。如果认为可行，我们建议尝试闭合复位内固定，如果无法获得满意的复位或固定，则转为切开手术。
