Retrospectively Analyze The Open Reduction And Internal Fixation Of Calcaneal Fractures

Objectivecalcaneal fracture is a common type of fracture clinic, where 75% of adult fractures are intra-articular fractures. When calcaneal fractures with articular surface(calcaneus bearing surface) damage from the next, the bearing surface multi-shift occurs, collapse, uneven surfaces, leading to the subtalar joint motion, force and movement disorders, caused by traumatic arthritis, causing the foot feeling, movement disorders, foot shape and affect the patient to walk normally. In this study, Sanders classification of calcaneal fracture classification methods, Sanders II, Sanders III, Sanders Ⅳ patients with fractures cut, reduction, internal fixation plates were observed in patients in clinical therapy. Methodbetween June 2005 to March 2013 in our hospital for treatment of calcaneal fractures in 60 patients, a total of 80 feet, which Sanders Ⅱ 20- foot, Sanders Ⅲ type 42 feet, Sanders Ⅳ type 18 feet. Patients underwent preoperative calcaneal anteroposterior, lateral and axial slices checks and Gissane angle and Bohler angle measurements. If Gissane angle ≥ 140 ° or ≤ 90 °, Bohler angle ≤ 15 °, the prior level of the calcaneus coronal CT scan and observe the subtalar joint surface conditions based on the results of CT images, and type according to Sanders classification criteria. Surgical methods: supine / prone position( feet) or lateral position( one foot), epidural anesthesia, in lateral calcaneal line "L" shaped incision, full-thickness subperiosteal free, fully exposed and observed with dice joints, from the joint and fracture site under. According to intraoperative situation as follows: articular surface so that a reset, if necessary, carry out graft after poking and restore its articular surface smoothness; lateral compression of the calcaneus, restore calcaneal width; selection of appropriate calcaneal bone plate by fixing the calcaneal tuberosity, intercept sudden, cuboid bone or calcaneus front of the lateral wall of the calcaneus to reach the fixed objectives. Indwelling drainage, surgery( not external fixation). All patients calcaneal axial line, anteroposterior and lateral radiographs checking, parallel Gissane Bohler angle and angle measurements. Statistical Methods: SPSS18.0 statistical software for data processing, analysis, measurement data using t test, count data using the chi-square test, test level a = 0.05, P <0.05 when the show obvious differences statistically significant. Results60 cases of calcaneal fractures were followed up rate of 100%, the follow-up time was 11 ~ 34(18.64 ± 6.48) months, all patients were bone healed without malunion, delayed union and nonunion patients. Seven patients underwent autologous bone grafts six patients underwent allogeneic bone graft, five cases of patients with mixed bone(autologous + allogeneic bone graft). Scoring system to evaluate foot function criteria( American Orthopaedic Foot and Ankle Society formulation) as Response Evaluation Criteria, calcaneal fracture treatment in patients with type Sanders Ⅱ excellent rate 95.0%, Sanders Ⅲ type calcaneal fracture patients excellent rate 78.6%, Sanders ⅳ calcaneal fracture patients excellent rate 72.2%; Sanders Ⅱ type calcaneal angle Gissane before Sanders Ⅲ patients with surgery and postoperative angle between the corresponding index Bohler significant difference was statistically significant(P <0.05); before Sanders Ⅳ calcaneal fracture surgery in patients with postoperative Bohler angle differences are significant, statistically significant(P <0.05); Sanders Ⅱ type, Sanders Ⅲ type, Sanders Ⅳ calcaneal fracture patients subtalar joint osteoarthritis phlebitis rates were 6.67%, 8.82%, 9.09%, the difference between groups was statistically insignificant(P> 0.05); Sanders Ⅱ type, Sanders Ⅲ type calcaneal fractures in patients with postoperative weight-bearing walking Sanders Ⅳ type pain scores were was(2.12 ± 0.97),(3.54 ± 1.05),(4.21 ± 2.34), the difference between groups was statistically insignificant(P> 0.05); Sanders Ⅱ type, Sanders Ⅲ type calcaneal fracture healing incision Sanders Ⅳ type a level ratio was 85.00%, 85.71%, 83.33%, the difference between groups was statistically insignificant(P> 0.05); Sanders Ⅱ type, Sanders Ⅲ type calcaneal fracture patients after Sanders Ⅳ type Kerr efficacy scores were( 89.76 ± 5.14),(87.34 ± 4.09),(85.51 ± 4.15), the difference between groups was statistically insignificant(P> 0.05). Conclusioncalcaneal fractures, particularly intra-articular fractures of clinical treatment, cut, reduction, fixation is a safe and effective treatment for the calcaneal bone plate, especially with the collapse of the articular surface Sanders Ⅲ, Sanders Ⅳ calcaneal fractures, clinical results were satisfactory, the prognosis is good, worthy of promotion in clinical practice applications.