Homeopathic closed leverage anatomical plate with compression bolt for treatment of displaced intra-articular calcaneal fractures / 中华创伤杂志

ABSTRACT

Objective To compare the treatment of displaced intra-articular calcaneal fractures by homeopathic closed leverage anatomical plate with compression bolt through small posterior lateral approach vs.traditional open reduction and internal fixation.Methods A retrospective case control study was made on 98 cases of displaced intra-articular calcaneal fractures admitted from September 2012 to May 2015.According to the random number table,the subjects were assigned to homeopathic closed leverage anatomical plating with compression bolt through small posterior lateral approach (experiment group,58 cases,66 sides) and open reduction and internal fixation through L-shape approach (control group,40 cases,45 sides).Experiment group consisted of 50 male and eight females cases aging from 27-56 years (mean,41.9 years),and the Sanders classification was 40 cases of type Ⅱ,24 type Ⅲ and two type Ⅳ.Control group consisted of 36 male and four female cases aging from 25-58 years (mean,43.7 years),and the Sanders classification was 25 cases of type Ⅱ,18 type Ⅱ and two type Ⅳ.Operation time,bone reduction,postoperative Bohler's angle,width of the calcaneum,and incision healing were recorded.Functional outcomes were evaluated with Maryland hindfoot scoring system at last follow-up.Results Operation time was (52.6 ± 11.2) min in experiment group,significantly shorter than that in control group [(86.4 ± 14.1) min] (P ＜ 0.01).All cases were followed up from 18-50 months (mean,30.8 months).Reduction of the calcaneal posterior facet in 53 sides (80％) was graded as nearly anatomical in experiment group,and 38 sides (84％) in control group (P ＞ 0.05).Postoperative Bohler's angle was (28.0 ± 6.2) ° in experiment group,and (26.8 ± 7.0) ° in control group (P ＞ 0.05).Width of the calcaneum was (31.3 ±3.6)mm in experiment group and (34.9 ± 4.0)mm in control group (P ＜ 0.01).All cases presented satisfactory shape of the calcaneus without lateral-side impact syndrome.No case had wound infection and incision-edge necrosis in experimental group,while two cases of superficial wound infection and three cases of incision-edge necrosis were found in control group (P ＜ 0.01).At last follow-up,Maryland hindfoot score was (87.1 ± 7.6)points in experiment group and (84.9 ± 9.1)points in control group (P ＞ 0.05).Conclusion Homeopathic percutaneous leverage and anatomical plate with compression bolt through small posterior lateral approach is an effective method for treatment of displaced intra-articular calcaneal fractures,for it has advantages of minimal invasion,less operation time,good reduction and function,and less wound complications.