Checa-Betegón P, Valle-Cruz J, Llanos-Sanz S, Miguel-Miguel C, Sánchez-Del-Saz J, García-Coiradas J
Department of Traumatology and Orthopaedic Surgery, Complex Trauma Unit, Hospital Universitario Clínico San Carlos, Carlos. Profesor Martín Lagos sn, 28040, Madrid, Madrid, Spain.
Complejo Hospitalario de Navarrra., C. de Irunlarrea, 3, 31008, Pamplona, Spain.
Eur J Orthop Surg Traumatol. 2024 Jan;34(1):201-208. doi: 10.1007/s00590-023-03621-y. Epub 2023 Jul 5.
The therapeutic management of calcaneal fractures is currently a major source of controversy in the literature. There is no consensus on the need to treat these injuries conservatively or surgically, nor on the criteria for deciding one option or the other. Although the gold standard has classically been the open approach and osteosynthesis, there are currently minimally invasive techniques that also report good results. Our objective is to present our results and experience with the MBA Orthofix external fixator in a series of cases of calcaneal fractures.
We performed a retrospective observational study in our center, between the years 2019 and 2021, of Sanders types II-IV calcaneal fractures operated with MBA Orthofix external fixator. We recorded a total of 38 patients, 42 fractures. We registered demographic information, intraoperative, postoperative, radiological and functional parameters, using the American Orthopedic Foot and Ankle Society (AOFAS), Manchester-Oxford Foot Questionnaire (MOXFQ), EQ-5D and VAS scales.
A total of 26 men and 12 women were included, and the median age was 38 years. Mean follow-up was 24,4 months (6, 8-40, 1). The average time to surgery was 7 days and partial loading was started at 2.5 weeks after external fixation, which was removed at 9.2 weeks. The average Böhler angle correction was 7, 4°, Gissane - 12,2°, length 2 mm and calcaneal width was reduced by 5 mm. We recorded two superficial infections, one peroneal entrapment and three subtalar arthrodesis due to post-traumatic osteoarthritis. The AOFAS obtained was 79.1 + / - 15.7 points, MOXFQ 20.1 + / - 16.1 points, EQ-5D 0.84 + / - 0.2 and VAS 3.3 + / - 1.9.
The external fixator is an excellent surgical alternative for complex articular fractures of the calcaneus, obtaining clinical and radiological results comparable to other osteosynthesis techniques and significantly reducing soft tissue complications.
跟骨骨折的治疗方法目前在文献中存在很大争议。对于这些损伤是采用保守治疗还是手术治疗，以及决定采用哪种治疗方法的标准，目前尚无共识。尽管传统上金标准是切开复位内固定术，但目前一些微创技术也取得了良好效果。我们的目的是介绍我们在一系列跟骨骨折病例中使用MBA Orthofix外固定器的结果和经验。
我们在2019年至2021年期间在我们中心对采用MBA Orthofix外固定器治疗的Sanders II-IV型跟骨骨折进行了一项回顾性观察研究。我们共记录了38例患者，42处骨折。我们使用美国足踝外科协会（AOFAS）、曼彻斯特-牛津足部问卷（MOXFQ）、EQ-5D和视觉模拟评分（VAS）量表记录了人口统计学信息、术中、术后、放射学和功能参数。
共纳入26名男性和12名女性，中位年龄为38岁。平均随访时间为24.4个月（6.8 - 40.1个月）。平均手术时间为7天，外固定后2.5周开始部分负重，9.2周时拆除外固定。平均Böhler角矫正7.4°，Gissane角矫正12.2°，长度增加2mm，跟骨宽度减少5mm。我们记录了2例浅表感染、1例腓总神经卡压和3例创伤后骨关节炎导致的距下关节融合。获得的AOFAS评分为79.1±15.7分，MOXFQ评分为20.1±16.1分，EQ-5D评分为0.84±0.2，VAS评分为3.3±1.9。
外固定器是治疗跟骨复杂关节骨折的一种优秀手术选择，其临床和放射学结果与其他内固定技术相当，且显著减少了软组织并发症。
