Thor Jessica, Socklingam Raj, Kon Charles
Orthopaedic Surgery, Changi General Hospital, Singapore, SGP.
Cureus. 2024 Sep 2;16(9):e68428. doi: 10.7759/cureus.68428. eCollection 2024 Sep.
Displaced intra-articular calcaneal fractures have been proven to be challenging for orthopaedic surgeons worldwide due to the poor clinical outcomes. Historically, the decision whether for fixation or conservative management depended mostly on the literature of the time, initially favouring conservative management but attitudes slowly shifted to operative intervention. Percutaneous fixation options have been increasingly popular for their ability for fracture reduction without skin and wound complications of the open method. A retrospective study of 17 patients with a total of 18 calcaneal fractures treated in our hospital by a single surgeon from January 2017 to December 2019 was conducted. Fixation was done percutaneously using cannulated screws, with the patients in a lateral position. Intraoperative imaging was done using a mini-image intensifier to visualise fracture reduction, and the O-arm was used in most cases. Using the Sanders classification, there were a total of 4 IIA, 3 IIB, 2 IIC, 2 IIIAB, and 7 IIIAC. Results showed that 16 calcaneal fractures (94%) had good to excellent outcomes with the American Orthopedic Foot and Ankle Society (AOFAS) score and Maryland Foot Score (MFS), while 14 calcaneal fractures (78%) showed good to excellent outcomes with the Kerr calcaneal score. There were no wound complications encountered in our series. However, there was one patient with a k-wire broken intraoperative and left in situ and there were two patients with prominent screws. Despite this, our experience with percutaneous fixation of displaced intra-articular calcaneal fractures has been generally favourable, allowing for good outcomes and satisfactory reduction of the fracture fragments.
由于临床效果不佳，移位的关节内跟骨骨折已被证明对全球骨科医生来说都是一项具有挑战性的治疗难题。从历史上看，选择固定治疗还是保守治疗主要取决于当时的文献，最初倾向于保守治疗，但态度逐渐转向手术干预。经皮固定方法因其能够实现骨折复位且无开放手术的皮肤和伤口并发症而越来越受欢迎。我们对2017年1月至2019年12月期间在我院由同一位外科医生治疗的17例患者共18例跟骨骨折进行了回顾性研究。采用空心螺钉经皮固定，患者取侧卧位。术中使用小型影像增强器进行成像以观察骨折复位情况，大多数情况下使用O型臂。根据Sanders分类，共有4例IIA、3例IIB、2例IIC、2例IIIAB和7例IIIAC。结果显示，根据美国矫形足踝协会（AOFAS）评分和马里兰足部评分（MFS），16例跟骨骨折（94%）的治疗效果为良好至优秀，而根据克尔跟骨评分，14例跟骨骨折（78%）的治疗效果为良好至优秀。我们的系列病例中未出现伤口并发症。然而，有1例患者术中克氏针折断并留在原位，有2例患者的螺钉突出。尽管如此，我们经皮固定移位关节内跟骨骨折的经验总体上是令人满意的，能够取得良好的治疗效果并使骨折碎片得到满意复位。
