Knapik Derrick M, Hermelin Michael J, Tanenbaum Joseph E, Vallier Heather A
Department of Orthopaedic Surgery, MetroHealth Medical Center, Affiliated with Case Western Reserve University, Cleveland, OH.
OTA Int. 2019 Dec 20;2(4):e049. doi: 10.1097/OI9.0000000000000049. eCollection 2019 Dec.
To assess complications and secondary operations in patients treated with either open reduction and internal fixation (ORIF) versus percutaneous fixation of displaced intra-articular calcaneus fractures.
Retrospective comparative study.
Level 1 trauma center.
PATIENTS/PARTICIPANTS: Ninety-three adult patients with 111 fractures treated by a single orthopaedic traumatologist between 2001 and 2014.
ORIF through an extensile lateral approach or percutaneous reduction and internal fixation.
Wound-healing complications, infections, posttraumatic arthrosis (PTOA), and secondary procedures.
Fifty patients with 58 fractures underwent ORIF, and 43 patients with 53 fractures had percutaneous fixation. Mean age was 43 years, and 80% were male. Open fractures and two-part fractures were more often treated percutaneously (26% vs 8%, = 0.03) and (49% vs 31%, = 0.02), respectively. Patients undergoing percutaneous fixation were more often tobacco users (58% vs 36%, = 0.04) and with history of alcohol and other substance abuse. Twenty-seven patients (29%) had 28 complications, including 21% with PTOA, with no differences based on type of treatment. Six patients had secondary procedures, with no difference based on type of treatment. Patients with open fractures ( = 0.001) or tobacco abuse ( = 0.005) were more likely to experience complications.
No differences in complication rates were found for ORIF versus percutaneous fixation. Regardless of fixation technique, patients with open fractures or history of tobacco abuse were more likely to develop complications. Percutaneous reduction and fixation represents an alternative to extensile ORIF in terms of similar early and late complications, particularly in high risk patients.
Therapeutic Level III.
评估切开复位内固定（ORIF）与经皮固定治疗移位性关节内跟骨骨折患者的并发症及二次手术情况。
回顾性比较研究。
一级创伤中心。
患者/参与者：2001年至2014年间由一名骨科创伤专家治疗的93例成年患者，共111处骨折。
通过扩大外侧入路进行切开复位内固定或经皮复位及内固定。
伤口愈合并发症、感染、创伤后关节炎（PTOA）及二次手术情况。
50例患者58处骨折接受了切开复位内固定，43例患者53处骨折接受了经皮固定。平均年龄43岁，80%为男性。开放性骨折和两部分骨折更常采用经皮治疗（分别为26%对8%，P = 0.03）和（49%对31%，P = 0.02）。接受经皮固定的患者吸烟比例更高（58%对36%，P = 0.04），且有酒精及其他物质滥用史。27例患者（29%）出现28种并发症，其中21%有创伤后关节炎，不同治疗方式之间无差异。6例患者接受了二次手术，不同治疗方式之间无差异。开放性骨折患者（P = 0.001）或有吸烟史患者（P = 0.005）更易出现并发症。
切开复位内固定与经皮固定在并发症发生率上无差异。无论采用何种固定技术，开放性骨折患者或有吸烟史患者更易发生并发症。经皮复位及固定在早期和晚期并发症方面与扩大切开复位内固定相似，是一种替代方法，尤其适用于高危患者。
治疗性三级证据。
