| Objective: This study aimed to compare functional recoveries of Sanders Type Ⅲ calcaneal fractured treated by open reduction and plate fixation through lateral L-shaped approach or open reduction and plate fixation combined with sustentaculum tali screws fixation through extended lateral approach.Methods: The patients with Sanders type Ⅲ intra-articular calcaneal fractures treated in our department from October 2014 to October 2017 were randomly divided into Observational group and Control group.Patients in Observational group were treated with open reduction and plate fixation combined with sustentaculum tali screws fixation through extended lateral approach.During the operation,the articular fracture fragments and the main body fracture fragments were firstly reduced.They were fixed with the use of sustentaculum tali screws and then subsequently with plate-screws fixation.Patients in Control group were fixed with plate and screws after fracture reduction through traditional L-shaped lateral approach.General information of the patients,operative time,amount of bleeding,complications and the calcaneal length,width and height,B?hler and Gissane angles measured on the preoperative X-ray films and postoperative radiographs taken on 1 week and 12 months after the operation.The functional recovery was evaluated according to American Orthopaedic Foot and Ankle Society(AOFAS)score at 12 months after the operation.Results: There were 21 patients enrolled in the observation group,among whom 4 patients were followed up less than 12 months.This group includes 17 men and 0 woman,Seventeen men aged 28-55 years(with an average age of 42.0±9.7 years)were followed up for 14 to 24 months(with an average follow-up time of 18±3 months)were included into final analysis.There were 22 patients enrolled in the the control group,among whom 5 patients were excluded due to followed up less than 12 months.Seventeen patients were followed up for 13 to 26 months(with an average follow-up time of 18±4 months).This group includes 16 men and 1 woman,aged 21 to 56 years(with an average age of 43.1±9.6 years).No significantly statistical differences were found in the issues such as gender,age,preoperative waiting time,amount of bleeding and operation time between both groups(all P> 0.05).However,compared with the observation group,the period of hospital stay was longer in control group,the complications were higher while the incision healing rate in 2 weeks after surgery was lower in the control group(significant differences found between both groups with all P<0.05).The measurements of calcaneus on the radiographs taken on one week after the operation(calcaneal length: 77.18±5.63 mm,width:38.89±7.34 mm and height:47.71±4.33 mm,B?hler angles:25.03±6.86 and Gissane angles:120.02±5.92 were significantly different from those preoperative ones(calcaneal length:85.13±7.30 mm,width:48.49±6.72 mm and height:43.87±5.75 mm,B?hler angles:3.82±9.62 and Gissane angles:85.35±10.51 in the observation group(all P<0.05).For B?hler and Gissane angles,there were no significant differences in the observation group between those measured on one week postoperatively andand those on 12 months after the operation(both P > 0.05).Meanwhile,the parameters of calcaneus measured on the preoperative radiographs(calcaneal length:83.42± 6.10 mm,width:46.24±4.98 mm and height:42.26±6.80 mm,B?hler angles: 4.56±9.27 and Gissane angles:85.55±7.12 in X-ray images)were significantly different from those measured on the radiographs taken on one week postoperatively(calcaneal length:80.02±5.71 mm,width:40.03±1.93 mm and height:46.73±6.02 mm,B?hler angles:26.44±3.66 and Gissane angles: 123.06±5.33 in the control group(all P<0.05).B?hler angles(25.83±3.75)and Gissane angles(122.26±5.62)measured on 12 months after the operation in the control group were not found with statistical differences with those measured on 1 week after the operation(all P> 0.05).While there were no significant differences in these issues between both groups(all P>0.05).The AOFAS scores between the observation group(the excellent and good rate:88.24%,total scores:86.9±7.5)and the control group(the excellent and good rate:76.47%,total scores:83.3±12.5)was not statistically different(P > 0.05).Nevertheless,there is a significant difference in score of the hind foot motion between the observation group(score:5.8±0.7)and the control group(3.4±1.0))(P<0.05).Conclusion: Compared with open reduction and plate fixation through traditional lateral approach,open reduction and plate fixation combined with sustentaculum tali screws fixation through extended lateral approach can achieve satisfactory clinical outcomes with shortening hospital stay and less incision complications,strengthened joint stability and improved joint stiffness in the treatment of Sander type Ⅲ calcaneal fracture.Sustenta-culum tali screws fixation can improve the supporting role and angle stability,which allows early postoperative functional exercise and reduce the risk of subtalar joint stiffness. |
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