Chongmuenwai Adisorn, Thitirangsi Tharit
Department of Orthopedics, Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand.
Indian J Orthop. 2023 Jan 19;57(3):461-465. doi: 10.1007/s43465-023-00823-8. eCollection 2023 Mar.
Displaced intraarticular calcaneus fracture indicates surgical treatment. The current trend is open reduction and internal fixation with a plate or multiple screws through the sinus tarsi approach. Most postoperative protocols are prolonged non-weight bearing that causes a high socioeconomic burden. This study aims to determine the safety of the early weight-bearing protocol of screws-only fixation in calcaneal fracture.
Evaluate displaced intraarticular calcaneus fractures treated with screws-only technique via the sinus tarsi approach in our institution. The first group, from July 2017 to December 2018, allowed patients to start partial weight bearing as tolerated at 4 weeks after surgery. The second group prospectively from January 2019 to March 2020, which assign patients to keep non-weight bearing for 8 weeks. The functional outcomes (Thai Foot and ankle ability measure subjective form, FAAM) were measured 6 months after surgery. The radiographic outcome (Bohler's angle and Gissane angle) was measured on the first day postoperative and 6 months follow-up, and the changes in these angles were recorded.
There were 28 patients in each group. The outcomes were collected and compared by a -test. In the early weight-bearing group, The FAAM, Bohler's angle loss, and Gissane's angle change were 76.4 ± 14.8, 2.4 ± 3.5, and 6.6 ± 7.8, respectively. In the delayed weight-bearing group, The FAAM, Bohler's angle loss, and Gissane's angle change were 81 ± 14.8, 2 ± 1.8 and 2.6 ± 6.1, respectively. There was no statistically significant difference in FAAM score, Bohler's angle loss, and Gissane's angle change between early and delayed weight-bearing groups.
Screws fixation in calcaneal fracture may be safe to allow early weight-bearing protocol.
移位的关节内跟骨骨折需要手术治疗。当前的趋势是通过跗骨窦入路使用钢板或多枚螺钉进行切开复位内固定。大多数术后方案是长时间不负重，这会带来很高的社会经济负担。本研究旨在确定跟骨骨折单纯螺钉固定早期负重方案的安全性。
评估在我们机构采用跗骨窦入路的单纯螺钉技术治疗的移位关节内跟骨骨折。第一组，从2017年7月至2018年12月，允许患者在术后4周根据耐受情况开始部分负重。第二组前瞻性地从2019年1月至2020年3月，让患者保持8周不负重。术后6个月测量功能结果（泰国足踝能力测量主观量表，FAAM）。在术后第一天和6个月随访时测量影像学结果（Bohler角和Gissane角），并记录这些角度的变化。
每组有28例患者。通过t检验收集并比较结果。在早期负重组中，FAAM、Bohler角丢失和Gissane角变化分别为76.4±14.8、2.4±3.5和6.6±7.8。在延迟负重组中，FAAM、Bohler角丢失和Gissane角变化分别为81±14.8、2±1.8和2.6±6.1。早期和延迟负重组之间的FAAM评分、Bohler角丢失和Gissane角变化没有统计学显著差异。
跟骨骨折螺钉固定允许早期负重方案可能是安全的。
