Laparoscopia con preservación de órgano en lesión esplénica en dos tiempos por traumatismo cerrado de abdomen / Laparoscopy with spleen preservation for delayed splenic rupture due to blunt abdominal trauma

RESUMEN El tratamiento no operatorio (TNO) de lesiones abdominales en traumatismo cerrado de abdomen (TCA) se basa en pilares clínicos y radiológicos. Presentamos el de caso de paciente masculino de 16 años que ingresa en el Servicio de Emergencias por dolor abdominal en hipocondrio izquierdo y antecedente de traumatismo cerrado de abdomen reciente. Se establece protocolo de TNO basado en cuadro clínico e imágenes pero, en forma posterior, ante la evolución desfavorable, se cambia la conducta y se realiza tratamiento laparoscópico conservador de órgano.

ABSTRACT Nonoperative management (NOM) of organ injuries in abdominal blunt trauma (ABT) is based on clinical and imaging test findings. We herein present a 16-year-old male patient with a history of recent blunt abdominal trauma was admitted to the emergency department for abdominal pain in the left hypochondrium. A protocol for NOM was established based on the clinical picture and imaging findings, but afterwards, in view of the unfavorable progression, the approach was modified to laparoscopic organ-preserving surgery.

STEPPING TOWARDS NON-SURGICAL MANAGEMENT: STUDY IN A TERTIARY CARE CENTRE IN A DEVELOPING NATION

Objective: To assess the emerging trend of Non-operative Management and image guided interventions over surgery in a tertiary care hospital in a developing nation. Data regarding patients who underwe Methods: nt Non-Operative Interventions (NOI) or Non-Operative Management (NOM) in VMMC and Safdarjung hospital, New Delhi, India over past 3 years was collected retrospectively from hospital database. Max diameter of liver abscess mana Results: ged nonoperatively ranged from 3.5 to 14 cm. Mean diameter was 7.15 +/- 3.20 cm. Mean volume of the abscess was 538 ml. 43.33% of the abscesses were ruptured. 73.33% of the patients underwent pigtail insertion and the rest underwent ultrasound guided aspiration. 12 patients underwent PTBD in the center over past 3 years. All the patients had malignant etiology of some sort. 75% patients had carcinoma of Gall bladder, and the rest had biliary stricture of malignant nature. Conclusion: NOIs have revolutionized management of several entities for which surgery was sole resort until few decades back. However, these facilities come with their own set of limitations. There is a paucity in literature in the developing world regarding outcome of NOI

Lesión quirúrgica de vía biliar compleja. Manejo conservador / Complex bile duct injury. Conservative management

RESUMEN La colecistectomía laparoscópica es el tratamiento de elección para la litiasis vesicular sintomática. Aunque la tasa de complicaciones es baja, las lesiones de la vía biliar representan un grave problema. La asociación con una lesión vascular (lesión compleja) genera un impacto adicional, disminuyendo la calidad de vida y la sobrevida a largo plazo. Presentamos el caso de una paciente con lesión compleja por compromiso vascular del pedículo hepático derecho que desarrolló una atrofia del parénquima correspondiente. Ante la ausencia de complicaciones sépticas, el tratamiento no operatorio pudo realizarse en forma exitosa.

ABSTRACT Laparoscopic cholecystectomy is considered the standard of care for symptomatic cholelithiasis. Although the rate of complications is low, bile duct injuries represent a serious problem. The association with vascular injury (complex injury) poses an additional impact by reducing the quality of life and long-term survival. We report the case of a female patient with complex injury due to vascular involvement of the right hepatic pedicle who developed right liver atrophy. Non-operative management was successful due to the absence of septic complications.

A prospective study of injury pattern and outcome of blunt trauma abdomen patients in a tertiary care hospital in eastern part of India

Background: Abdominal trauma continues to account for a large number of trauma-related injuries and deaths. The evaluation and treatment of abdominal injuries are critical components in the management of severely injured trauma patients. The study was done to study pattern and outcome of BTA patients in a tertiary care hospital in eastern part of India as few studies exist in this part of the country.Methods: Prospective descriptive study conducted in in SRN Hospital, Prayagraj over a period of one year with all cases of blunt injury abdomen included with respect to inclusion criteria.Results: In our study mean age was 23.2±17.6 years. 92% were male and 8% were female RTA are responsible for most number of cases (78%). Conservative management done in 34 (68.0%) and Operative Intervention done in 16 (32.0%) cases. In our study, X-ray erect had 75% accuracy total subsets of 336 organ scans were performed on ultrasound specific injury was seen in total 50 cases and total 210 CT scans performed was able to pick up 59 injuries (p=0.0002). CECT forms the core investigation of choice in dealing with blunt injury abdomen cases. In our present study, paralytic ileus (prolonged) (31%) and pelvic intraabdominal abscess (31%) as postoperative complications.Conclusions: CECT abdomen is the investigation of the choice with RTA being the most common mode of BTA. So effort should be made to implement traffic rules. Hemodynamic instability with radiological findings useful in deciding operative versus conservative management of blunt trauma patients.

Role of Conservative Management in High Grade Renal Injuries: Our Experience at a Tertiary Care Centre

Introduction: Renal injuries account for up to 1–5% of alltrauma related injuries. Over the years there has been a shifttowards non-operative treatment for blunt renal trauma. Theaim of our study was to assess outcomes of patients managedconservatively (non-operatively) for high grade blunt renalinjury at our centre.Material and methods: The study was conducted in aretrospective manner using hospital records of last 5 years. Allpatients with blunt renal injuries were included. These patientswere categorized based on AAST(1989) injury gradingand further subdivided into operative and non-operativemanagement groups. These management strategies wereanalyzed in terms of ‘failure of non- operative management’,complications and need for adjunctive procedures. Descriptiveanalysis was done using Microsoft Excel(2010, ver14)software.Results: Forty three patients were included in the study witha mean age of 44.6 years. Out of the total, 28 had grade I– III injuries, 11 had grade IV and 4 had grade V injuries.All the grade I-III patients were managed conservatively andrequired no adjunctive procedures. One (9%) of grade IV and2(50%) of grade V injuries underwent immediate exploration.Out of 10 cases of grade IV injuries which underwent nonoperative management, 3(30%) required delayed explorationand none of the grade V injuries required delayed exploration.Complications included urinary tract infection (UTI) (6 cases),persistent hematuria (3 cases), hypertension(2 cases), urinoma(2 cases) and ileus(2 cases) .All complications were Claviengrade 1-2 with no mortalities overall.Conclusion: If the patient is hemodynamically stable,even grade IV and V blunt renal injuries can be managedconservatively, as is seen in our study where failure of nonoperative management occured in only 30% of grade IV andnone of the Grade V injuries.

Current status regarding selective non-operative management of abdominal gunshot wounds / 解放军医学杂志

Laparotomy should be routinely performed in the cases of abdominal gunshot wounds. However, recent studies found that 20%-30% abdominal gunshot wounds were non therapeutic or negective, and some complications secondary to laparotomy, such as local infection, often developed. Selective non-operative management (SNOM) can reduce the incidence of operative complications, length of hospitalization, and medical cost, thus has been recommended for the patients with abdominal blunt and stabbing wounds. However, it remains obscure whether SNOM is suitable for patients with abdominal gunshot wounds and which patients should be suitable for SNOM. This paper aims to review the important findings from questionnaire survey, clinical practice studies, and large-scale systematic reviews, and then propose how to identify the candidates for SNOM, hoping to be helpful for improving our management strategy of abdominal gunshot wounds.

Prospective Study of Management of Solid Organ Injury in Blunt Trauma Abdomen

Blunt injury to abdomen is one of the most common injury caused by road traffic accidents. The advent of newer imaging techniques with high resolution computed tomography scanners (CT scan) has enabled the clinicians to exactly diagnose the extent of the intra abdominal injuries. High grade injuries are commonly managed by surgery but the shift to selective non operative management (NOM) of blunt injuries to abdominal solid organs are one of the most notable trends in the case of trauma. Methods: This study was conducted on 50 patients of blunt abdominal trauma admitted in Guru Nanak Dev Hospital, attached to Govt. Medical College, Amritsar. Patients of all age groups with blunt trauma abdomen were admitted in hospital. Results: In the present study, most common age group affected was 21-40 years (70%); out of which males were more commonly affected (90%); most common mode of injury was road traffic accident accounting for 76% of patients of all age groups. In this study, 2 out of 13 patients expired who were kept on NOM due to liver injuries. Failure to resuscitate these patients was the main cause of mortality. 4 out of 12 operative cases expired. Most common organ injured was liver (50%) followed by spleen (36%). Other organs injured were pancreas and kidney, 6% each. Mortality rate in patients who were receiving NOM was 5.26% while patients who received operative management had mortality rate of 33.3%. Conclusion: Morbidity and mortality can be prevented by timely initial resuscitation and correct diagnosis as well as management (non operative or operative) which depends on patient’s hemodynamic stability and findings of imaging studies.

Are Gap and Cast Indices Predictors of Efficacy of Reduction in Fractures of Both Bones of the Leg? A Cohort Study

@#Introduction: Non-operative management has successfully been practised for long in diaphyseal fractures of both bones of the leg. This study attempts to establish an acceptability criteria for plaster cast in order to predict future loss of reduction and its adequacy. Materials and Methods: A total of forty subjects were included as per inclusion-exclusion criteria. Gap and cast indices were calculated in the immediate post reduction phase and at third week follow-up visit. Results: The mean values of gap and cast indices in the immediate post-reduction phase were 0.35±0.220 and 0.99±0.08 respectively and at the third week follow-up the mean value for both the parameters in those without loss of reduction were 1.11±0.50 and 1.03±0.09 respectively and in those with loss of reduction were 0.84±0.44 and 1.01±0.06 respectively. Conclusion: Gap and cast indices are not informative in assessing adequacy of reduction in diaphyseal fractures of both bones of the leg.

Role of Therapeutic endoscopy vs surgery in the management of traumatic pancreatic injury – A tertiary referral center experience

Background: Pancreatic injury remains a complicated condition requiring an individualized case by case approach to management. In this study, we aim to analyze the varied presentations and treatment outcomes of traumatic pancreatic injury in a tertiary care center. Materials and methods: All consecutive patients hospitalized at our center with traumatic pancreatic injury between 2013 and 2017 were included. The American Association for Surgery of Trauma (AAST) classification was used to stratify patients into five grades of severity. Outcome parameters were then analyzed based on the treatment modality employed. Results: Of the 35 patients analyzed, 26 had an underlying blunt trauma with the remaining 9 presenting due to penetrating injury. Overall in-hospital mortality was 28%. 19 of these patients underwent exploratory laparotomy with the remaining 16 managed non-operatively. 9 patients had severe injury (>grade 3) – of which 4 underwent endotherapy, 3 had stents placed and one underwent an endoscopic pseudocyst drainage. Among those managed non-operatively, 3 underwent a radiological drainage procedure. Conclusion: Mortality rates were clearly higher in patients managed operatively. This is likely a result of significantly higher degrees of major associated non-pancreatic injuries and not just a reflection of surgical morbidity. Despite this, surgical management remains the mainstay of therapy, especially in higher grades of pancreatic injury. However we would like to emphasize that endoscopic intervention definitely remains the preferred treatment modality when the clinical setting permits. This is especially applicable in cases of main pancreatic duct injury with ascites as well as pseudocysts.

Successful Non-operative Management of Intra-abdominal Hemorrhage in Two Patients with Hemophilia A / 임상소아혈액종양

Spontaneous intra-abdominal hemorrhages are uncommon in hemophilic patients. They can cause complications in patients with severe hemophilia, and are associated with a high mortality rate. To date, there is no guideline for the management of intra-abdominal hemorrhage in patients with hemophilia. Management of intra-abdominal hemorrhage ranges from conservative treatment to emergent embolization or surgery. We describe two children with hemophilia A, who were successfully treated non-operatively by administering coagulation factor concentrates and embolization, and were later discharged from the hospital. We emphasize the role of an active approach in the evaluation and management of intra-abdominal hemorrhage without any surgical intervention.

Blunt Trauma Pancreas in Children: Is Non-Operative Management Appropriate for All Grades? / 대한소아소화기영양학회지

PURPOSE: Blunt trauma of pancreas in children is uncommon and its management varies from observational to early operative intervention. We analysed the feasibility and outcome of non-operative management in all grades of paediatric pancreatic injuries. METHODS: A total of 15 patients of pancreatic trauma seen in a Paediatric Surgery Unit were retrospectively analyzed. RESULTS: Age of the patients ranged from 3–11 years (mean, 7.7 years). The mode of injury was local trauma in 9 children. Only 3 patients had associated injuries and all were haemodynamically stable. Serum amylase levels were raised in 12 patients at admission which ranged from 400–1,000 IU. Computed tomography scan made a correct diagnosis in 14 patients. Grades of the injury varied from grade I–V (1, 3, 6, 4, 1 patients respectively). Fourteen patients were managed conservatively. One patient underwent laparotomy for suspected superior mesenteric hematoma. The average duration of enteral feeds was 3.7 days and of hospital stay was 9.4 days. Six patients formed pancreatic pseudocysts; two were managed conservatively while the other four underwent cystogastrostomy. The patients were followed up for a period of 1–12 years. All remained asymptomatic and none had exocrine or endocrine deficiencies. CONCLUSION: Non-operative treatment for isolated blunt trauma of pancreas in children may be safely followed for all the grades of injury; if associated injuries requiring surgical intervention are ruled out with a good quality imaging and the patients are hemodynamically stable. It did not increase the hospital stay and morbidity and avoided operative intervention on acutely injured pancreas.

Blunt Trauma Pancreas in Children: Is Non-Operative Management Appropriate for All Grades? / 대한소아소화기영양학회지

PURPOSE: Blunt trauma of pancreas in children is uncommon and its management varies from observational to early operative intervention. We analysed the feasibility and outcome of non-operative management in all grades of paediatric pancreatic injuries. METHODS: A total of 15 patients of pancreatic trauma seen in a Paediatric Surgery Unit were retrospectively analyzed. RESULTS: Age of the patients ranged from 3–11 years (mean, 7.7 years). The mode of injury was local trauma in 9 children. Only 3 patients had associated injuries and all were haemodynamically stable. Serum amylase levels were raised in 12 patients at admission which ranged from 400–1,000 IU. Computed tomography scan made a correct diagnosis in 14 patients. Grades of the injury varied from grade I–V (1, 3, 6, 4, 1 patients respectively). Fourteen patients were managed conservatively. One patient underwent laparotomy for suspected superior mesenteric hematoma. The average duration of enteral feeds was 3.7 days and of hospital stay was 9.4 days. Six patients formed pancreatic pseudocysts; two were managed conservatively while the other four underwent cystogastrostomy. The patients were followed up for a period of 1–12 years. All remained asymptomatic and none had exocrine or endocrine deficiencies. CONCLUSION: Non-operative treatment for isolated blunt trauma of pancreas in children may be safely followed for all the grades of injury; if associated injuries requiring surgical intervention are ruled out with a good quality imaging and the patients are hemodynamically stable. It did not increase the hospital stay and morbidity and avoided operative intervention on acutely injured pancreas.

Successful Non-operative Management of Intra-abdominal Hemorrhage in Two Patients with Hemophilia A / 임상소아혈액종양

Spontaneous intra-abdominal hemorrhages are uncommon in hemophilic patients. They can cause complications in patients with severe hemophilia, and are associated with a high mortality rate. To date, there is no guideline for the management of intra-abdominal hemorrhage in patients with hemophilia. Management of intra-abdominal hemorrhage ranges from conservative treatment to emergent embolization or surgery. We describe two children with hemophilia A, who were successfully treated non-operatively by administering coagulation factor concentrates and embolization, and were later discharged from the hospital. We emphasize the role of an active approach in the evaluation and management of intra-abdominal hemorrhage without any surgical intervention.

Study Of Clinical Outcomes In Patients With Severe Hepatic Injury: Experience At A Tertiary Care Centre.

Background: Management of liver trauma earlier used to be primarily surgical. With advancement in diagnostic modalities it has gradually shifted to non operative management. Methods: The present study was conducted on 40 patients with severe hepatic injuries (grade 3 onwards). All the patients were compared in terms of various methods adopted for their management and their clinical outcomes Results: Out of a total of 40 patients, maximum numbers of patients were in age group 18-24 years. 82.50 % patients had grade IV and rest had Grade V. 12 patients presented with shock on admission. Failure of NOM (non operative management) was seen in 25% of cases . The average requirement of blood transfusion in our study was 2.157 1.74 units. Average hospital stay in successful NOM cases was lower than in failed NOM. A total of 6 patients had to be operated upon in our study. Active bleed was seen on laparotomy in four patients with no evidence of any injury causing peritonitis. Conclusion: The success rates of non-operative management were significantly higher than the failures rates of non-operative management, without any significant incidence of complications and delayed laparotomies. Grade of liver injury or the amount of hemoperitoneum as detected on CT scan did not influence the outcome of non-operative management. Non-operative management is thus the gold standard in hemo-dynamically stable patients.

Tratamento não operatório de 1.768 pacientes portadores de lesões das vísceras maciças abdominais por trauma contuso atendidos no Hospital João XXIII / Non-operative treatment of 1,768 patients with lesions in the abdominal massive viscerae caused by blunt trauma, tended at the João XXIII Hospital

Objetivos: Analisar os resultados obtidos com a implantação do protocolo de tratamento não operatório (TNO) do trauma abdominal contuso no Hospital João XXIII (HJXXIII). Métodos: Estudo retrospectivo em pacientes submetidos ao TNO vítimas de trauma abdominal contuso atendidas no HJXXIII no período de novembro de 2004 a dezembro 2013. Resultados: Durante o período, 1.768 pacientes preencheram os critérios de inclusão. Do total, 17 pacientes (0,99%) apresentavam lesões das três vísceras,197 (11,1%) de duas vísceras e 1.554 (87,9%) de uma víscera. Os 1.768 pacientes tinham 1.999 lesões assim distribuídas: 790 (39,5%) lesões hepáticas, 761 (38%) esplênicas e 448 (22.5%) renais. Na lesão hepática, a falha foi de 4,3%. As lesões graus II e III foram as mais frequentes - 74,2% do total. Nesse grupo de pacientes o índice de falha não superou2%. Nas lesões graus IV e V a falha foi mais frequente, ocorrendo em, respectivamente, 12,5 e 25% dos pacientes. Na lesão esplênica a falha de TNO foi de 7,9%. As lesões graus II e III foram as mais comuns - 75,3% do total de pacientes. A falha do TNO foi maior na lesão esplênica grau III (11,3%) e grau IV (33,3%). O sangramento foi a causa principal dafalha. Na lesão renal a falha foi de 6,6%. As lesões graus II e III foram as mais frequentes (63,3%). O TNO falhou em 22,8% dos pacientes com lesão grau IV. Conclusão: o sucesso do TNO depende do grau de lesão, recursos institucionais e protocolo inflexível.

Objectives: to analyze the results obtained with the implementation of the non-operative treatment protocol (TNO) for blunt abdominal trauma in the João XXIII Hospital (HJXXIII). Methods: this was a retrospective study of patients submitted to TNO, victims of blunt abdominal trauma and tended at the HJXXIII, between November of 2004 and December of 2013. Results: a total of 1,768 patients met the inclusion criteria. Seventeen patients (0.99%)presented lesions in the three viscerae, 197 (11.1%) in two viscerae, and 1,554 (87.9%) in one viscera. The 1,768 patients had 1,999 lesions distributed as follows: 790 (39.5%) liver lesions, 761 (38%) splenic, and 448 (22.5%) renal. Failure was 4.3% in liver lesions, Grades II and III lesions were the most frequent - 74.2% of the total. In this group of patients the failure index was not over 2%. Failure was more frequent in Grades IV and V lesions occurring in, respectively, 12.5 and 25% of the patients. TNO failure was 7.9% in splenic lesions, Grades II and III lesions were the most common - 75.3% of the patients. TNO failure wasgreater in splenic lesions grade III (11.3%) and IV (33.3%). Bleeding was the main cause of failure. Failure was 6.6% in renal lesions. Grades II and III lesions were the most frequent (63.3%). TNO failed in 22.8% of patients with grade IV lesion. Conclusion: the success of TNO depends on the lesion grade, institutional resources, and an inflexible protocol.

Manejo del absceso diverticular / Management of the diverticular abscess

Introducción: el absceso diverticular (AD) es la complicación más común de la diverticulitis. Actualmente no hay consenso en definir su mejor estrategia terapéutica. Objetivos: describir las características clínicas de los pacientes con AD y su evolución según tamaño, ubicación y manejo. Material y Método: estudio descriptivo de pacientes con AD hospitalizados en el Hospital Militar, durante el período 2009-2012. Resultados: se hospitalizaron 22 pacientes con diagnóstico de AD, con edad promedio de 65.2 años, el 63% eran mujeres, y las comorbilidades más frecuentes fueron hipertensión arterial, diabetes mellitus e hipotiroidismo. Todos consultaron por dolor abdominal y se encontraban hemodinámicamente estables al ingreso. 15 casos eran AD pericolónicos: 7 AD = 3 cm con buena respuesta a tratamiento médico; 4 AD de 3-5 cm, en este grupo se instaló drenaje percutáneo (DPC) en 3 pacientes de los cuales 2 requirieron cirugía; 4 AD > 5 cm, sólo en un caso se realizó DPC y ningún paciente requirió cirugía. Siete casos eran AD pélvicos o retroperitoneales: 4 AD de 3-5 cm con respuesta favorable a manejo médico; 3 AD > 5 cm, sólo un caso se manejó con DPC y ninguno requirió cirugía. Se realizó una sigmoidectomía electiva sólo en 5 casos, los 15 pacientes restantes han evolucionado satisfactoriamente durante 15.73 meses de seguimiento. No hay mortalidad en esta serie. Conclusión: es factible el manejo conservador de AD > 5 cm de diámetro. No hay mayor recurrencia de diverticulitis en pacientes con AD, independiente del tamaño, ubicación y manejo inicial.

Background: diverticular Abscess (DA) is the most common complication of diverticulitis. Currently, there is no consensus on defining the best therapeutic strategy against it. Objectives: to describe the clinical characteristics of DA patients and their evolution according to size, location and management. Materials and Methods: descriptive study of DA patients hospitalized in Militar Hospital in the period 2009-2012. Results: 22 patients diagnosed with DA were hospitalized (mean age was 65.2, 63% being women). The most frequent comorbidities were high blood pressure, diabetes mellitus and hipothyroidism. All the patients complained about abdominal pain and were hemodynamically stable when admitted. Fifteen cases were pericolonic DA: 7 DA = 3 cm responding well to medical treatment; 4 DS between 3-5 cm (in this group, percutaneous drainage (PCD) was applied to 3 patients, out of which 2 required surgery); 4 AD > 5 cm (in this group, PD was applied to only one patient and none required surgery). Elective sigmoidectomy was performed in only 5 cases; the other 15 patients have recovered satisfactorily during 15.73 months of follow-up. There is no mortality in this series. Conclusion: conservative management of DA > 5 cm in diameter is feasible. There is no considerable recurrence of diverticulitis in DA patients, despite the size, location and early management.

Analyse selective non-operative management of closed splenic injuries in 98 cases / 重庆医学

Objective To discusses the methods of the case selection and monitoring and diagnosis and treatment to selective non-operative management of closed splenic injuries .Methods The clinical data and results of 98 cases from October 1999 to Octo-ber 2011 with closed splenic injuries managed non-operative treatment were analyzed retrospectively .Results There were 90 cases (91 .8% ) conservative successfully ,5 cases(5 .1% ) transit operation because hematoma increase and bleeding continuously during therapeutic observation and 2 cases(3 .1% ) died from multiple injuries merge infection and multiple organ failure .Conclusion Most of the closed splenic injuries below level Ⅱcan be treated by non-operative management ,the effect and prognosis determined by the reasonable case selection and monitoring conditions and diagnosis and treatment .

The advances and trends in the management of liver trauma / 中华肝胆外科杂志

Liver is the largest parenchymal organ in human body and the most commonly injured organ in abdomen,accounting for 20％ of all abdominal traumas.Traumatic liver rupture can bring about intra-abdominal hemorrhage,peritoneal irritation and hemorrhagic shock.If the liver trauma takes place in peri-hepatic veins or multiple-organ injury,mortality rate is increased.In recent years,with more studies on liver injury and the rapid development of modern surgical techniques as well as the equipments,the strategies and means of liver trauma treatment have greatly changed.These changes include liver trauma cases with nonoperative treatment have been increased gradually,the improvement of damage control packing,the application of fast-track surgery concept in liver trauma,etc.

Mesentric Panniculitis : A Rare Clinical Entity.

Mesenteric panniculitis is a rare, fibrosing inflammatory disease of the mesentery. Its presents with a variety of symptoms and is diagnosis is mostly by CT scan abdomen. We present a case report of a 48 years old gentleman with symptoms of mainly pain abdomen. He was treated conservatively and subsequently improved.

Non operative and simple operative managements of calcaneal fractures / 中华创伤骨科杂志

Objective To evaluate non operative and simple operative managements of the calcaneal fractures. Methods 97 patients with calcaneal fractures were treated by non operative management or percutaneous reduction with wires or screw fixation from April 1997 to December 2001 in our department. They were followed up for more than 2 years. 64 patients were treated with non operation, 27 were fixed with wires and 6 with screws. Results 23 patients had excellent results, 67 good, 5 fair and 2 poor. The total good and excellent rate was 92.7%. 2 patients experienced secondary arthrodesis 1 year after injury. Conclusion Although the calcaneal fractures can be treated satisfactorily with non operative management or percutaneous reduction with wires or screws fixation, further prospective and comparative studies should be done in clinic to determine whether the calcaneal fractures should be treated with open reduction and fixation or with simple operative management.