Clinical efficacy of crossing cannulated screw fixation for treatment of intra-articluar calcaneal fractures / 中华创伤杂志

ABSTRACT

Objective To assess the clinical results of crossing cannulated screw fixation for intra-articulsr calcaneal fractures.Methods A total of 65 patients (72 sides) were retrospectively studied from July 2012 to June 2015 by case-control study,including 63 males and two females at age range of 18-70 years [(45.7 ± 12.2) years].According to the Sanders classification,there were 49 fractures of type Ⅱ (25 type Ⅱa,17 type Ⅱb,7 type Ⅱc) and 23 fractures of type Ⅲ (12 type Ⅲab,6 type Ⅲac,5 type Ⅲ bc).The cases had been divided into two groups,namely,the crossing caunulated screw fixation group (CCSFG group,30 cases) and plate fixation group (PFG group,42 cases).The results were compared with regard of the hospitalization time,fracture reduction and union,AOFAS score system,and complications.The calcaneal shape was assessed by the length,width,height,Bhler angle and Gissane angle.The foot function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score system.Results All were followed up for 6-24 months [(15.2 ± 4.7)months],and presented fracture healing.The time of hospitalization was (10.2 ± 2.3)days (7-14 days) and (18.6 ±3.3)days (13-28 days) in CCSFG and PFG groups,respectively(P ＜0.05).At the first and final visits during follow-up,the changes in calcaneal width and B(o)hler angle of CCSFG group were smaller than that of PFG group (P ＜ 0.05).For Sanders Ⅱ type cases,the average AOFAS function scores in CCSFG and PFG groups were (89.3 ± 6.8) points and (90.1 ± 8.1) points,respectively (P ＞ 0.05).For Sanders type Ⅲ cases,the corresponding scores in CCSFG and PFG groups were (83.5 ± 10.8) points and (82.5 ±7.3)points,respectively (P ＞0.05).The complication rate in the CSFG and PFG groups was 20％ and 19％,respectively (P ＞ 0.05).Conclusions Compared with the plate fixation,the crossing cannulated screw fixation has advantages of less invasion,better stability,shorter hospitalization time,faster functional recovery and can be recommended as the first choice for mild to moderate comminuted calcaneal fractures.