ABSTRACT
Objective To report the clinical outcomes of the patients with open comminuted intra-articular calcaneal fracture who were treated with our self-designed bilateral triangle external fixators which are extensible and gimbaled.Methods Between January 2011 and June 2014,12 patients with open comminuted intra-articular calcaneal fracture were treated and followed up.They were 8 men and 4 women,aged from 23 to 58 years (average,36.8 years).According to the Sanders classification,the fractures were type Ⅱ in 4 cases,type Ⅲ in 7,and type Ⅳ in one.According to the Gustilo classification,the soft tissue injury was type Ⅱ in 2 cases,type ⅢA in 7,and type Ⅲ B in 3.All the patients were treated with immediate debridement and preventive intravenous antibiotics.First stage wound closure or temporary coverage with vacuum sealed drainage was chosen according to the condition of soft tissue injury.Our self-designed bilateral triangle external fixators were applied together with cannulated screws or Kirschner wire in all the patients after Kirschner wire poking.Of them,7 received emergency treatment and 5 were treated 3 to 5 days after injury.After no wound infection was observed for sure,6 cases received selective open reduction and internal fixation via a lateral incision while 6 continued external fixation with Kirschner wire for 8 to 10 weeks (average,9.1 weeks).Results The 12 patients were followed up for 6 to 36 months (average,18.5 months).Their AOFAS scores averaged 84.6 points (range,from 74 to 94 points).One case required tissue transfer for wound coverage.Wound shallow infection developed in 3 cases.No deep infection or amputation happened.No wound infection or necrosis occurred in the 6 cases that had undergone open reduction and internal fixation at the second stage.Conclusion Application of our self-designed extensible gimbaled bilateral triangle external fixators in the treatment of open comminuted intra-articular calcaneal fractures may help effectively reduce the deep infection or incidence of osteomyelitis after operation as long as early debridement is thorough,internal fixation is timely applied,and indications for internal fixation are properly followed.
ABSTRACT
The diagnosis and treatment characteristics of head-wind sha in She medicine were analyzed and summarized. By visiting She-nationality villages and towns in Zhejiang province and Fujian province and interviewing hundreds of doctors of She medicine, the sha diagnosis, sha differentiation, experience and theory of treatment were arranged, and a comprehensive summary on theory and application of head-wind sha in She medicine such as pathogeny, name of disease, mechanism, diagnosis, differential diagnosis and treatment was made. It is believed that the methods of diagnosis and treatment in She medicine for head-wind sha could effectively enhance curative effect, safety and patients' quality of life, and the further research should be carried out.