| Objective To observe the clinical effective of internal objective cure SanderⅡ-Ⅳstandard calcaneus fracture, and it's attentions and complications.Methods Review and analysis of 53 cases 64 feet of internal objective cure calcaneus fractures in NO.208 hospital of PLA. Among them,41 male cases,12 female cases,18-62ages,36 ages average.Unilateral 42 cases, bilateral 11 cases. According the Sanders typing,Ⅱ18 feet,Ⅲ33 feet,Ⅳ13 feet, fall injury 27cases, traffic injury 18cases, military training injury 4 cases and others 4 cases. Closed fracture 39cases, open fracture 14cases. Complications:high blood pressure 5cases, coronary heart disease 3cases, diabetes mellitus 7cases, polytopy fracture 4cases. Injury to operation time 3h to 20d,7.5d average.56 feet using internal objective cure by calcaneus plates. Follow-up complications, cure time and function judging.Results:Follow-up 41cases 49feet, from 5-33months,19 months average. Fracture curing from 8 to 15 weeks,12.1 weeks average, most no displacement, interlocking nailing fixed and no break and remove. Among the total, there was one foot nails removed, then, taken out the internal fixation and made the twice opreation of joint fusion. Partial skin necrosis 3 feet, infection 2feet, one of them cured by skin flap transplantation, others by change of dressing. The follow-up feet's were reshaped, no malformation. Of all there were 9 feet which had made bone graft, including self ilium and allochthonous bone. Follow-up 7cases, no reaction. Among Maryland standard:Superior 34 feet, fine 11 feet, good 4 feet, The excellent and good rate was 91.8%. The emerging complications above may caused by following reasons:1. delayed operation for edema diminished; 2. do not pay attention to protective flap during operation; 3. may caused by too early pull up drainage-tube; 4. Premature weight loading functional exercise, especially for Sander IV type.Comparative follow-up patients'last X-ray, and calcaneus morphologic, the shape of calcaneus, Bohler corner and Gissane corner obviously reformed. The difference have statistics meaning (P<0.05).Patients have normal gait, no limp, no on tiptoe and other syndrome.Due to northeast climate arescent, earth solid, four seasons clearly, soliders often are injured in military trainning, and it's one of the reasons in our discussing cases. nowadays,there are too many literatures about calcaneus fracture, but less on military trainning injury, and lack of its epidemiologic study. What the reason is maybe that military is a specific group, difficulty to investigate and study, even affect to the result of analysis. We took suction 1200 soldiers stochastic for relation to the disease epidemiologic study from one military department near our hospital. It is similar that soldier ages, arm of the services, trainning projects and intension. So the background parameter and results of the sample is more controlled and credible than other group. The results can provide renference about prevention and cure of calcaneus fracture for soldiers and young people at the same time.Conclusion By the follow-up, we can believe:sanderⅡ-Ⅳcalcaneus joint fractures appliance internal objective can reform joint level off, rebuilt Bohler corner and Gissane corner, reform anatomise and burden demand, in favor of function resume, reduce syndrome,long-term effective. To Sander IV type which it is serious comminuted fracture of calcaneus, there is also good prognosis by calcaneus plate internal-fix. With respect to some unsuccessful cases, we could operate a joint fusion at the second time.Points for attention:1. selective operation as far as possible; 2. operation till skin fold appearance; 3. Reduce operation and tourniquet time; 4. familiarity anatomise of operative approach; 5.full screen cut and keep clear of skin to protect it, acute abruptio cutis; 6. Prevent cut after operation is an effective track. |
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