The analysis of complications following internal fixation of the intra-articular calcaneal fractures / 中华骨科杂志

ABSTRACT

Objective To discuss the complications following internal fixation of intra-articular calcaneal fractures and its prevention and treatment. Methods From January 1997 to July 2002, 59 sides of calcaneal fractures in 54 patients were treated with open reduction and Y-shaped plate fixation through lateral approach, most of them supplemented by autogenous bone grafting. According to Sanders classification, 20 sides were accounted for typeⅡ, 24 for type Ⅲ, 15 for type Ⅳ. During operation, lateral roentgenograms were made to assess Bler angle and Gissane angle, Broden view was made to evaluate congruency of the posterior facet. The wounds were drained underneath the lateral flap to prevent hematoma formation. Perioperative antibiotics were used routinely. All the cases were followed-up for an average of 17 months(range, 9 to 48 months). Results The clinical results were evaluated according to Maryland Foot Score, excellent results achieved in 30 cases, good in 21, fair in 6, poor in 2; excellent and good rate was 86.4%. Early complications were found in 4 cases(6.8%). Among them, 2 cases of wound necrosis were treated with suture after resection of necrotic tissue or covered with flap grafts, 1 case of wound infection recovered after dressing changes, 1 case of sural nerve injury recovered uncompletely without any special treatment. Late complications were found in 2 cases(3.4%) with obvious chronic pain, the patients were treated by subtalar arthrodesis and relieved from pain later. Conclusion The complications of internal fixation to fractures are related to anatomic features of calcaneus and their injury mechanism. Serious complications can be minimized in several ways as follows optimal time for operation and preoperative design should be carefully considered, a full-thickness flap is recommended in avoidance of excessive distraction, bone grafting is needed to support intra-articular fracture fragments and to enhance the stability of internal fixation, the affected extremity should be immobilized by plaster and elevated, and perioperative use of antibiotics.The appropriate management should be taken in cases of complications.