Effective comparison between nonoperative and operative treatment in calcaneal fractures / 中国矫形外科杂志

ABSTRACT

[Objective]To evaluate the effect of nonoperative and operative treatment in calcaneal fractures.[Method]Operative effect of 38 cases of calcaneal fracture of all kinds(42 foots)were analyzed.Accordind Essex-Loprestis classification,6 foots suffered type I tongue fracture,28 foots suffered compressed fracture(type Ⅱ),8 foots suffered serious comminuted fracture(type Ⅲ).All patients underwent open reduction interal fixation by Buttress plate(AO calcaneal fracture plate or simulated AO calcaneal fracture plate made domestically) from the extended "L" lateral approach.Postoperatively,no patient needed plaster fixation.All patients started non-weight-bearing fuctional exercise at 2-3days,gradual weight-bearing walking at 6-8 weeks.The result of operated group was compared with nonoperative treatment group.The follow-up period was from 10 months to 36 months,with an average of 17monthes.[Result]Assessed the effect by Maryland foot score,the base line included every foot.Total excellent and good rate in operative group was 93%,it was 100% in type I fracture group,96% in type Ⅱ fracture group,75% in type Ⅲ fracture group.The result of nonoperative treatment group wastotal excellent and good rate was 67%,it was 92% in type I fracture group,77% in type Ⅱ fracture group,there was not excellent and good patients in type Ⅲ fracture group.[Conclusion]It is important to regain the flatness of subtalar joint and calcaneocuboid joint,maintain the normal shape of foot.The authors recommend that type Ⅱ and type Ⅲ fractures of calcaneus according Essex-Loprestis classification were treated with open reduction and interal fixation by Buttress plate.By selecting the appropriate approach,proper reducting and postoperative treating rightly,it is an ideal measure to treat calcaneal fracture by selection of treatment method acciding to patient's individual status and fracture type.