The Clinical Study Of Using Plate With Open Reduction And Internal Fixation For Cure Calcaneal Fracture

ObjectiveThe calcaneal anatomic has complex forms and irregular structure.The fracture oftenleads to the collapsed and crushed articulation surface. It is hard to reduce fracture. Theaccuracy of reduction for ar-ticular surface is low and has high morbidity. This articleaims to investigate the surgical techniques with open reduction internal fixation cure forcalcaneal fracture, and that to prevent from postoperative complications, as well as toobserve the clinical curative effect.MethodsIn this study,45patients (56feet) that hospitalized with complete follow-up dataduring April2010to April2013were with intra-articular calcaneal fractures and sanderstypeⅡ-Ⅳ.There were38males(46feet) and7females (10feet). Ages ranged from15to59years old and the average age is（36.16±14.63）years old. There were19left feet,15right feet and11double feet. According to Sanders classification, there were4feet oftype II fractures,38feet of type III fractures, and14feet of type Ⅳfractures. The causesof injuries incl-ude high falling injury (41patient), traffic injury (3patients), and bruise injury by heavy object (1patient), combined with Lumbar fractures (9patients),traumatic brain injury (1patient), other fractures (7patients). Actively improve thepreoperational examination. Make a surgical plan. Select the appropriate timing ofoperation. The patients who injured severity were made fracture model with rapidprototyping technology. We treated all the cases with open reduction internal fixation.Recovered the calcaneal anatomic form by surgical. Measured and compared thenumbers of B hler angle and Gissane angle before and after operation;Observed andcompared the numbers of B hler angle which belong tothe locking plate group (21cases)and the common steel plate group (24cases) to evaluate the situation of reduction. Thepatients after operation were evaluated with Maryland Foot Score and were observed theearly and the late complications and the activities of feet function in order to evaluate theclinical effect.ResultsAll cases（56feet）were all followed up in8-40months after the operation which is18.6months in average. One case had Sural nerve symptoms. Three cases hadpostoperative incisional skin exudate,Two of them the incision were drying and healingafter3weeks by anti-infection and dressing change and the other one had the skinnecrosis and the plate exposure was repaired by free flap transplantation and goodfracture healing. Three cases had traumatic arthritis. Two of them used conservativetreatment and symptomatic treatment for pain relief and the other one had recovered wellafter operation by subtalar arthrodesis. According to Maryland Foot Score,30calcareouswere excellent,19good,7moderate and0bad. The excellence to good rate was87.50%.There were significant difference between the pre-operation and post-operation of B hlerangle and Gissane angle after using the paired T-test. There were no significant differencebetween locking plate group and the common steel plate group of B hler angle afterusing the T-test of independent sampler.ConclusionsOpen reduction and internal fixation is widely accepted for calcaneal intra-articularfracture. The patients who injured severity were made fracture model with rapid prototyping technology, Minimally invasive and accurately direct surgical treatment,calcaneal anatomic form recovery and subtalar joint surface. It can make patients exerciseearlier, promote foot function recovery, and reduce disabilities.Hold the operation indication strictly. It can use the open reduction and plate fixationfor calcaneal fractures of sanders typeⅡ-Ⅳ. Before the operation, we should pay attentionto the local soft-tissue and choose the reasonable surgical timing. During operation, begentle and reduce the fractures accurately and rigidly, recovery subtalar joint surfaceAvoid the poor wound healing and the traumatic arthritis and other complications.We do not advocate early Subtalar joint arthrodesis for the comminuted calcanealfractures of SandersⅣ.We suggest the first open reduction and internal fixation in order torecover the calcaneal anatomic form and apply anatomic landmarks and bony frameworkfor the long-term subtalar joint arthrodesis, and to get satisfied curative effects.For the selection of plate, there were no significant differences between locking plategroup and the common steel plate group in this study. May be related to the locking plateused in severe comminuted fracture. We tend to choose the locking plate for severecomminuted fracture in order to enhance stability and reliability of the fracture fixation.Footscan system can be objective and real evaluation of patients with post-operationfuction recovery, guidance of recovery exercise.