Department of Orthopaedic Surgery, Qingdao University, Qingdao, China.
Department of Burn and Plastic Surgery, No. 971 Hospital of the People's Liberation Army (PLA), Qingdao, China.
Orthop Surg. 2021 Feb;13(1):225-236. doi: 10.1111/os.12902. Epub 2021 Jan 5.
To assess the clinical outcomes of open calcaneal fractures with medial wounds treated with one-stage management, including early modern wound care, sequential reduction, and frame structure fixation using percutaneous Kirschner wires.
A total of 19 patients with open calcaneal fractures admitted to our hospital from May 2016 to March 2019 were selected in this study. Twelve type-II and seven type-IIIA medial open injuries were identified according to the classification of Gustilo and Anderson. Fractures were stratified by Sanders classification, including nine type-II fractures, seven type-III fractures, and three type-IV fractures. All patients accepted one-stage irrigation and debridement, sequential reduction of calcaneal fractures through the open medial wound, percutaneous Kirschner wire fixation, and primary closure of wounds covered with vacuum-assisted closure (VAC) device. The Bohler angle, the Gissane angle, and the width of the calcaneus were compared before and after surgery. The functional results were evaluated according to the Paley and Hall score system, visual analogue scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score, Maryland Foot Score, and related complications.
The follow-up duration for all patients ranged from 14 to 28 months (mean, 22.7 months). The angle of Bohler and Giasane was increased from (-7.6° ± 15.0°) and (96.6° ± 7.6°) before surgery to (23.7° ± 6.1°) and (124.1° ± 7.1°) postoperatively (P < 0.05), respectively. Three cases of superficial infection and two cases of wound dehiscence were observed in our study, which were then successfully treated with wound debridement, VAC replacement, appropriate use of antibiotics, and delayed closure. The last follow-up revealed three cases of lateral wall expansion and six cases of mild-to-moderate subtalar arthritis based on the Paley and Hall scoring system. According to the AOFAS ankle and hindfoot score, one case showed excellent results, 14 cases exhibited good results, and four cases displayed fair results, with the mean of 80.7 ± 6.7 points (range, 70-90). The Maryland Foot Score revealed one case of excellent outcomes, nine cases of good outcomes, and nine cases of fair outcomes with an average of 76.8 ± 8.6 points (range, 62-90). The mean VAS for pain was 1.8 ± 1.5 (range, 0-5), and a total of 14 patients complained of mild-to-moderate pain when walking for a more extended period. Severe complications, such as deep infection, osteomyelitis, and soft tissue necrosis, were not observed during follow-up.
Collectively, one-stage management allowed the direct restoration of calcaneal morphology with a minimal invasion of soft tissues in most open calcaneal fractures with medial wounds, and the functional outcomes were comparable to previous data.
评估内侧伤口的开放性跟骨骨折采用一期处理，包括早期现代伤口护理、序贯复位和经皮克氏针框架结构固定，其临床结果。
本研究选取了 2016 年 5 月至 2019 年 3 月我院收治的 19 例开放性跟骨骨折患者。根据 Gustilo 和 Anderson 的分类，确定了 12 例 II 型和 7 例 IIIA 型内侧开放性损伤。根据 Sanders 分类，骨折分为 II 型 9 例、III 型 7 例和 IV 型 3 例。所有患者均接受一期冲洗清创、通过开放内侧伤口序贯复位跟骨骨折、经皮克氏针固定，以及使用真空辅助闭合（VAC）装置覆盖的伤口一期闭合。比较术前和术后的 Bohler 角、Gissane 角和跟骨宽度。根据 Paley 和 Hall 评分系统、视觉模拟评分（VAS）、美国矫形足踝协会（AOFAS）踝关节和后足评分、马里兰足部评分和相关并发症评估功能结果。
所有患者的随访时间为 14 至 28 个月（平均 22.7 个月）。Bohler 和 Giasane 角分别从术前的（-7.6°±15.0°）和（96.6°±7.6°）增加到术后的（23.7°±6.1°）和（124.1°±7.1°）（P<0.05）。本研究中观察到 3 例浅表感染和 2 例伤口裂开，通过伤口清创、VAC 置换、适当使用抗生素和延迟闭合，均成功治疗。末次随访时，根据 Paley 和 Hall 评分系统，发现 3 例外侧壁扩张和 6 例轻度至中度距下关节炎。根据 AOFAS 踝关节和后足评分，1 例为优秀结果，14 例为良好结果，4 例为可接受结果，平均为 80.7±6.7 分（范围为 70-90）。马里兰足部评分显示，1 例为优秀结果，9 例为良好结果，9 例为可接受结果，平均为 76.8±8.6 分（范围为 62-90）。疼痛的平均 VAS 为 1.8±1.5（范围为 0-5），14 例患者在长时间行走时抱怨轻度至中度疼痛。随访期间未观察到深部感染、骨髓炎和软组织坏死等严重并发症。
总体而言，一期处理允许在大多数伴有内侧伤口的开放性跟骨骨折中直接恢复跟骨形态，最大限度地减少对软组织的侵袭，其功能结果与之前的数据相当。
