Reed Logan A, Mihas Alexander, Andrews Nicholas A, Agarwal Abhinav, Wall Kevin C, Spitler Clay A, Johnson Michael D
Department of Orthopaedic Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
Foot Ankle Orthop. 2022 Aug 2;7(3):24730114221115678. doi: 10.1177/24730114221115678. eCollection 2022 Jul.
The sinus tarsi (ST) approach for calcaneus fractures has gained popularity in recent years with an increased interest in shifting to less invasive approaches for calcaneal fracture fixation allowing for adequate fixation if complications do not arise. Although the ST approach has gained acceptance as standard for calcaneus fracture fixation, the literature surrounding early complications rates based on age differences for this specific approach and pathology is lacking. The objective of this study was to determine if rates of complications based on age varied for patients undergoing open reduction and internal fixation (ORIF) of closed calcaneus fractures using the ST approach.
A retrospective review of patients undergoing ORIF for closed calcaneus fractures from 2012 to 2020 was performed. Inclusion criteria were based on an age greater than 18 years, surgical management of a closed calcaneus fracture using a ST approach, requirement of a preoperative computed tomographic scan, and a minimum of 180 days' follow-up. Patients were divided into 2 groups: those aged <50 years and those aged >50 years.
A total of 196 fractures were included with 114 fractures in the <50-year age group and 82 fractures in the >50-year age group. Mean age was 34.2 and 59.7 years in the younger and older groups, respectively. The older group had similar rates of wound dehiscence (1.2% vs 4.4%, = .204), superficial surgical site infection (1.2% vs 2.6%, = .490), deep infection (9.8% vs 7.9%, = .648), and nonunion (4.9% vs 3.5%, = .633) compared with the younger group. Rates of 30-day readmission, unplanned reoperation, and symptomatic hardware were not significantly different. Postoperative Bohler and Gissane angles were not significantly different between both groups.
Older patients with intraarticular calcaneus fractures treated via the ST approach maintain complication rates similar to those in younger individuals.
Level III, retrospective study.
近年来，跟骨骨折的跗骨窦（ST）入路越来越受欢迎，人们越来越倾向于采用侵入性较小的方法来固定跟骨骨折，前提是不出现并发症就能实现充分固定。尽管ST入路已被公认为跟骨骨折固定的标准方法，但针对该特定入路和病理情况，基于年龄差异的早期并发症发生率的相关文献却很匮乏。本研究的目的是确定采用ST入路对闭合性跟骨骨折进行切开复位内固定（ORIF）的患者，其并发症发生率是否因年龄而异。
对2012年至2020年接受闭合性跟骨骨折ORIF的患者进行回顾性研究。纳入标准为年龄大于18岁、采用ST入路对闭合性跟骨骨折进行手术治疗、术前需要进行计算机断层扫描以及至少随访180天。患者分为两组：年龄小于50岁的患者和年龄大于50岁的患者。
共纳入196例骨折患者，其中年龄小于50岁组有114例骨折，年龄大于50岁组有82例骨折。较年轻组和较年长组的平均年龄分别为34.2岁和59.7岁。与较年轻组相比，较年长组的伤口裂开发生率（1.2%对4.4%；P = 0.204）、浅表手术部位感染发生率（1.2%对2.6%；P = 0.490）、深部感染发生率（9.8%对7.9%；P = 0.648）和骨不连发生率（4.9%对3.5%；P = 0.633）相似。30天再入院率、非计划再次手术率和内固定物相关症状发生率无显著差异。两组术后的Bohler角和Gissane角无显著差异。
采用ST入路治疗的老年关节内跟骨骨折患者的并发症发生率与年轻患者相似。
三级，回顾性研究。
