Pflüger Patrick, Zyskowski Michael, Greve Frederik, Kirchhoff Chlodwig, Biberthaler Peter, Crönlein Moritz
Department of Trauma Surgery, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
Front Surg. 2021 May 28;8:620964. doi: 10.3389/fsurg.2021.620964. eCollection 2021.
Fractures of the calcaneus are severe injuries of the hindfoot, mostly resulting from high-energy axial loads, which still present enormous challenges to modern trauma surgery. Possible variables influencing the outcome are the type of fracture, age, and quality of fracture reduction. These might also be factors affecting the self-reported patient outcome, but large studies are still lacking. Therefore, the aim of this study was to analyze the patient-reported outcome of calcaneal fractures following operative and conservative treatment. All patients suffering from calcaneal fractures between 2002 and 2015 were enrolled in this retrospective analysis. The calcaneal fractures were classified according to Sanders and the AO classification system. For further analysis, two groups were formed: group I involved complex intra-articular fractures defined by the involvement of the posterior calcaneal facet, while group II consisted of extra-articular and process calcaneal fractures. Data were collected the patient registry, radiographs, and a standardized questionnaire (Foot and Ankle Outcome Score, FAOS). For outcome analysis, non-parametric Mann-Whitney -test was performed, and Spearman's rank correlation coefficient was calculated. In total, the functional outcome of 79 patients with calcaneal fractures was analyzed. In group 1 ( = 43), the mean FAOS score was 65.5 ± 18.9. The surgically treated patients with a Sanders type II calcaneal fracture had a mean FAOS score of 72.9 ± 17.2, type III fractures had 65.6 ± 20.8, and type IV had 61.1 ± 19 ( = 0.15). The reoperation rate was 22%, most frequently caused by wound complications (10%). The mean follow-up time was 64.5 ± 44 months. The mean FAOS score of group 2 ( = 36) was 75.2 ± 18.4, and 83% of the patients (=30) were managed conservatively. Only one out of six operatively managed patients had a reoperation due to regular implant removal. The mean follow-up time was 31 ± 25.9 months. Intra-articular calcaneal fractures are severe injuries of the hindfoot leading to a fair to poor functional outcome in the majority of the patients. Complications regarding wound healing are the most common causes for revisional surgery. Extra-articular calcaneal fractures are a heterogenous entity commonly managed non-operatively. Overall, they show a better functional outcome in comparison to intra-articular calcaneal fractures.
跟骨骨折是后足的严重损伤，大多由高能量轴向负荷所致，这对现代创伤外科手术仍然构成巨大挑战。影响预后的可能变量包括骨折类型、年龄和骨折复位质量。这些也可能是影响患者自我报告预后的因素，但仍缺乏大型研究。因此，本研究的目的是分析手术和保守治疗后患者报告的跟骨骨折预后。2002年至2015年间所有患有跟骨骨折的患者均纳入本回顾性分析。跟骨骨折根据Sanders和AO分类系统进行分类。为进一步分析，分为两组：第一组包括因跟骨后关节面受累而定义的复杂关节内骨折，而第二组包括关节外和跟骨突骨折。数据收集自患者登记册、X线片和一份标准化问卷（足踝结局评分，FAOS）。为进行预后分析，采用非参数Mann-Whitney检验，并计算Spearman等级相关系数。总共分析了79例跟骨骨折患者的功能预后。在第一组（n = 43）中，平均FAOS评分为65.5±18.9。接受手术治疗的Sanders II型跟骨骨折患者平均FAOS评分为72.9±17.2，III型骨折为65.6±20.8，IV型为61.1±19（p = 0.15）。再次手术率为22%，最常见的原因是伤口并发症（10%）。平均随访时间为64.5±44个月。第二组（n = 36）的平均FAOS评分为75.2±18.4，83%的患者（n = 30）接受保守治疗。六例接受手术治疗的患者中只有一例因定期取出植入物而再次手术。平均随访时间为31±25.9个月。关节内跟骨骨折是后足的严重损伤，大多数患者的功能预后为中等至较差。伤口愈合相关并发症是翻修手术最常见的原因。关节外跟骨骨折是一种异质性疾病，通常采用非手术治疗。总体而言，与关节内跟骨骨折相比，它们的功能预后更好。
