Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX.
J Foot Ankle Surg. 2022 Jul-Aug;61(4):771-775. doi: 10.1053/j.jfas.2021.11.013. Epub 2021 Dec 3.
Operative management displaced intra-articular calcaneus fractures is commonly associated with wound complications. Open reduction internal fixation is traditionally performed through the extensile lateral approach has relatively high rates of wound complications. The sinus tarsi approach to displaced intra-articular calcaneus fractures is a less invasive approach to achieve fracture reduction and fixation as well as reduce wound healing complications. The purpose of this study is to report the rates of wound complications associated with the sinus tarsi approach in the treatment of displaced intra-articular calcaneus fractures.
We retrospectively identified patients treated with a limited sinus tarsi approach for displaced intra-articular calcaneus fractures from January 2009 to December 2018. Demographic and radiographic data were collected including age, gender, mechanism of injury, occupation, presence of diabetes mellitus, smoking status, Sanders classification, Bohler and Gissane angles. Postoperatively, we recorded the presence of complications, return-to-work time, and radiographic measurements.
One hundred and five fractures were identified in 100 patients who underwent open reduction internal fixation for displaced intra-articular calcaneus fractures. Using the Sanders computed tomographic classification, we identified 32% Type 2, 48% Type 3, 18% Type 4, and 2% tongue-type variants. For the preoperative Bohler's angle, 38% of fractures displayed a negative angle, 50% had an angle 0° to 20°, and 12% over 20°. Postoperatively, all patients demonstrated an improvement in Bohler's angle with 13% with 0° to 20° and 87% over 20°. Approximately, 72% of patients working prior to the injury had returned to work by 6 months, and 89% by 12 months. The wound complication rate was 11.9% (12/105), with 1.9% (2/105) requiring additional procedures. There was no significant difference in wound complication rates in smokers versus nonsmokers (11.9% vs 12.2%, p = .55).
Operative management of displaced intra-articular calcaneus fractures through the sinus tarsi approach allows restoration of calcaneal height with a low rate of wound complications, even among active smokers.
手术治疗关节内移位跟骨骨折通常与伤口并发症有关。传统的切开复位内固定采用外侧扩大入路，其伤口并发症发生率相对较高。跗骨窦入路治疗关节内移位跟骨骨折是一种微创入路，可以实现骨折复位和固定，并降低伤口愈合并发症的发生率。本研究旨在报告跗骨窦入路治疗关节内移位跟骨骨折相关的伤口并发症发生率。
我们回顾性地确定了 2009 年 1 月至 2018 年 12 月期间采用有限跗骨窦入路治疗关节内移位跟骨骨折的患者。收集了包括年龄、性别、损伤机制、职业、是否患有糖尿病、吸烟状况、桑德斯分类、Bohler 和 Gissane 角在内的人口统计学和影像学数据。术后记录并发症的发生情况、恢复工作时间和影像学测量结果。
在 100 例接受切开复位内固定治疗关节内移位跟骨骨折的患者中，共发现 105 处骨折。根据桑德斯 CT 分类，我们发现 32%为 2 型，48%为 3 型，18%为 4 型，2%为舌型变异。术前 Bohler 角，38%的骨折呈负角，50%为 0°至 20°，12%大于 20°。术后，所有患者的 Bohler 角均得到改善，13%为 0°至 20°，87%大于 20°。大约 72%的受伤前有工作的患者在 6 个月时恢复工作，89%在 12 个月时恢复工作。伤口并发症发生率为 11.9%（12/105），其中 1.9%（2/105）需要进一步手术。吸烟者和非吸烟者的伤口并发症发生率无显著差异（11.9%比 12.2%，p=0.55）。
跗骨窦入路手术治疗关节内移位跟骨骨折可恢复跟骨高度，且伤口并发症发生率低，即使在活跃吸烟者中也是如此。
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