Analysis Of Clinical Therapeutic Effectiveness With Poking Reduction Combining Locking Compression Plate As External Fixation On The Treatment Of Sanders â…¡ Or â…¢ Type Calcaneus Fracture

[Background]In recent years,injury mechanisms of calcaneal fractures were complicated especially displaced intra-articular calcaneal fractures.Calcaneus fractures still remain in dispute in terms of the treatment way.Extended "L" type lateral approach to open reduction and internal fixation(ORIF) is the gold standard.However,it leaves too much soft tissue trauma because of the few lateral calcaneal local soft tissue and poor blood circulation.With the deepening of the concept of minimally invasive,the high incidence of skin necrosis and soft tissue infection brings more and more surgeons using minimally invasive surgery to treat calcaneal fractures.Because it can avoid soft tissue and reduce the incision complications at the maximum degree.There are many minimally invasive surgery methods,all of them have achieved a good clinical efficacy.However,the clinical research of poking reduction combining locking compression plate as external fixation on the treatment of Sanders Ⅱ or Ⅲ type calcaneus fracture was still not deep and enough,the operative security,clinical effectiveness,earlier and later complications should be discussed further.[Objective]To observe operative security and clinical effectivness of treating Sanders Ⅱ or Ⅲ type calcaneus fracture through the use of poking reduction combining locking compression plate as external fixation.Meanwhile,to analyze the reasons and therapeutic strategy for postoperative complications.[Methods](1)Between January 2012 and December 2014,52 patients with Sanders Ⅱ or Ⅲ type calcaneus fracture were selected according to the standards.All of 52 patients,25 cases underwent treatment of poking reduction combining locking plate as external fixation at random,and the others were treated with lateral L-shaped incision for open reduction and internal fixation(ORIF).There was no significant difference in gender,age, cause of injury, side of injury between 2 groups(P>0.05).Evaluating the safenessof the surgery by comparing the operating time, intraoperative blood loss,intraoperative X-ray exposure time, postoperative soft tissue infection between2 groups.X-ray measures the height,length and width of the calcaneus,the angle of Bohler and Gissane,meanwhile,observes the condition of fracture clinical healing. At last one year follow-up,the foot function was evaluated with Maryland score system.(2)A retrospective analysis of above-mentioned 25 cases underwent treatment of poking reduction combining locking plate as external fixation,the average follow-up was 22.4(18-36) months.Screw reaction,nerve injuries, peroneal tendon injuries,chronic pain were analyzed.At last follow-up, the foot function was evaluated with Maryland Foot Score System.[Results](1)The operation time,intraoperative blood loss, postoperative complications in trial group was significantly less than that in control group(P<0.05).Two groups of intraoperative X-ray exposure times were no significant difference(P>0.05),Two groups of postoperative radiological indicators were better than that of the preoperative(P<0.05),but there were no significantly statistical differences between the two groups(P>0.05).X-ray films indicated that all cases in 2 groups obtained fracture healing,there was no significant difference in the fracture healing time between 2 groups(P>0.05).At last one year follow-up,the Maryland score between two groups were no statistic significance(P>0.05).(2)All patients were followed,The average follow-up was 22.4(18-36) months.Maryland Foot Score System was used to evaluate clinical functional outcomes:excellent in 22 feet,good in 1 feet,fair in 1 feet and poor in 0 feet,The average Maryland Foot Score was 92.5,and the excellent and good rate was96%.Among them,3 cases of screw reaction,2 cases of nerve injuries,1 cases of peroneal tendon injuries,1 cases of chronic pain were found.[Conclution](1)Using the locking compression plate as external fixation to treat Sanders Ⅱ、Ⅲ type calcaneus fracture is an effective way when comparing to the traditional lateral L-shaped incision for open reduction and internal fixation,it has the same favorable foot function.Futhermore,it has smaller surgical trauma,shorter operative time,less soft tissue infection.As a result,poking reduction combining locking compression plate as an external fixation to treat Sanders Ⅱ、Ⅲ type calcaneus fractures has its advantages.(2)Using the locking compression plate as external fixation combining poking reduction to treat Sanders Ⅱ、Ⅲ type calcaneus fractures is an effective minimally invasive way,but postoperative complications were common.To effectively reduce some related complications, preoperative calcaneal anatomical stracture must be known, surgical technique and reasonable perioperative period management must be mastered.Moreover, suitable measures should be taken after the occurrence of certain complications.