Subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon for treatment of displaced intra-articular calcaneal fractures / 中华创伤杂志

ABSTRACT

Methods:A retrospective case-series study was performed to analyzed the data of 38 patients (38 feet) with displaced intra-articular calcaneal fractures admitted to Xuzhou Central Hospital from January 2016 to May 2018. There were 21 males (21 feet) and 17 females (17 feet), with the age of (33.7±6.2)years (range, 21-53 years). According to the Sanders' classification, 7 patients were classified as type II, 27 as type III and 4 as type IV. All patients underwent the procedure of subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon procedure. The operation time, intro-operative management, incision healing, and post-operative complications (nerve, vessels and tendon injuries)were recorded. B?hler angle, Gissane angle, length, width and height of the calcaneus, and bone healing time were recorded at postoperative 2 days and at final follow-up. The visual analogue score (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot scale, and Foot and Ankle Outcome Score (FAOS) were recorded at final follow-up, and were used to evaluate the clinical and functional outcomes.Results:All patients were followed up for 12-42 months [(18.7±5.3)months]. The operation time ranged from 45 to 100 minutes [(72.4±22.6)minutes]. Bone grafting was not observed, and microfracture of the posterior articular surface of the calcaneus were involved in 9 patients. The first-stage incision healing was achieved in all patients, without early complications of nerve, vessel and tendon injuries. The post-operative angles of B?hler and Gissane, length, width and height of the calcaneus were significantly improved compared to preoperative values ( P<0.01), while there were no significant difference at postoperative 2 days and at final follow-up ( P>0.05). At final follow-up, the VAS decreased from 5(3, 9)points to 0(0, 3)points, AOFAS improved from (68.3±10.5)points to (90.6±5.0)points, and FAOS improved from (66.9±9.1)points to (89.8±4.3)points, respectively ( P<0.01). According to the AOFAS ankle and hindfoot scale, the result was excellent in 27 patients, good in 8, and fair in 3, with the excellent and good rate of 92%. Conclusions:For displaced intra-articular calcaneal fractures, subtalar arthroscopy combined with locking plate fixation through anterolateral longitudinal incision of the Achilles tendon has advantages of precise fracture reduction, low postoperative complications and reliable functional outcomes.