Ortu Sebastiano, Brusoni Matteo, Pisanu Francesco, Caggiari Gianfilippo, Ciurlia Emanuele, Bienati Fabrizio, Manunta Andrea Fabio, Doria Carlo, Manca Mario
Orthopaedic Department, University of Sassari.
Orthopaedic Department, University of Cagliari.
Orthop Rev (Pavia). 2020 Aug 6;12(2):8506. doi: 10.4081/or.2020.8506.
Management of intra-articular heel fractures is controversial. The main goals of surgical treatment are restoring subtalar articular congruence and width, height, form and alignment of the heel. The gold standard is considered Open Reduction and Internal Fixation (ORIF), a complex technique with a high rate of complications. External Fixation (EF) could be a good alternative. In this study were identified 37 fractures in 35 patients (24 patients underwent ORIF and EF was performed in 13 cases) and the outcomes of the two techniques were compared. The mean surgical time for ORIF was 107.8 minutes, while for EF was 88.61 minutes and the ORIF group presented a higher rate of complications, despite of similar results in the mean postoperative AOFAS Ankle and Hindfoot Scale scores (73.31/100 points in the ORIF group and 75.40/100 points in the EF group). Fast learning curve, short surgery time and low complications rate make EF an alternative to ORIF in treating intraarticular heel fractures.
跟骨关节内骨折的治疗存在争议。手术治疗的主要目标是恢复距下关节的关节面一致性以及足跟的宽度、高度、形态和对线。金标准被认为是切开复位内固定术（ORIF），这是一种复杂的技术，并发症发生率较高。外固定术（EF）可能是一种很好的替代方法。在本研究中，共确定了35例患者的37处骨折（24例患者接受了切开复位内固定术，13例进行了外固定术），并比较了两种技术的结果。切开复位内固定术的平均手术时间为107.8分钟，而外固定术为88.61分钟，尽管术后AOFAS踝关节和后足评分的平均结果相似（切开复位内固定术组为73.31/100分，外固定术组为75.40/100分），但切开复位内固定术组的并发症发生率更高。快速的学习曲线、较短的手术时间和较低的并发症发生率使外固定术成为治疗跟骨关节内骨折时切开复位内固定术的一种替代方法。
