The Treatment Of Calcaneal Fracture With Percutaneous Poking Reduction Through The Gap Of Fractures And Internal Fixation With Canulated Screw

[Objective] To report on the treatment of calcaneal fractures by percutaneous poking reduction through the gap of fractures and internal fixation with canulated screw, and to retrospectively analyze the results in a group of patients treated by this technique. Mean while, a new thought of the treatment of calcaneal fractures is put forward.[Methods] In the period from June2010till June2011, a total of33patients with49closed calcaneal fractures with subtalar articular involvement were treated. The group had5women (6feet) and28men (35feet) with an average age of38.6years (range20-56years),which come from in-patient department of Traditional Chinese Medicine Hospital in Wuhan. According to Sanders classification,26feet were classified as type II,11type III,and4type Ⅳ. After the anesthesia, broken calcaneal was pressed from the lateral and medial with calcaneal clamp. Then, the Kirschner wire was broken the hell skin, got into the gap of fracture and poking the broken pieces. X-ray was taken to approve the effect of reduction. Two or three canulated screw (Φ4-4.5mm) fix fractures after percutaneous guide pins were appropriately placed, which one was put subtalar articular surface below. The foot was immobilized in a U type plaster after the operation. All patients were followed up regularly and were examined by an independent observer at the latest follow up. The clinical results were assessed using①Bohler angle, Gissane angle and Perie angle,②the height and width of the heel bone,③the American Orthopaedics Foot and Ankle Society(AOFAS) ankle-hindfoot score.[Results] All patients were followed up for9to15months (average12.7months).①Bohler angle, Gissane angle and Perie angle changed respectively from14.92°±5.61°,155.41°±10.33°,26.79°±5.44°to30.45°±4.98°,134.58°±6.62°,18.01°±3.23°;②calcaneal height and width33.50mm±1.30mm,40.63mm±2.50mm to44.62mm±0.78mm,36.98mm±1.82mm. There is significantly difference between before and after treatment (P<0.05). The excel lent and good rate of AOFAS ankle-hindfoot score was95.12%.[Conclusion] The treatment of intra-articular calcaneal fractures depends on anatomical repositioning of the subtalar joint. The advantages of percutaneous poking reduction through the gap of fractures is to jack up collapse bone piece, to recover the articular surface more easily, and restore the anatomy of the calcaneus more profitably. Using canulated screw can fix collapse fractures to remain the reduction. The advantages of the treatment of calcaneal fracture with percutaneous poking reduction through the gap of fractures and internal fixation with canulated screw has such merits as minimal invasion, rapid recovery,distinct effect, simple operaton and avoiding complications such as local skin necrosis and wound infection caused by open reduction and internal fixation. Compared with the traditional poking reduction,this method can maintain reduction of calcaneus, restore calcaneus structurel,recover function postoperatively.