[Study on clinical anatomy of calcaneal fractures and its applications].

OBJECTIVE: To observe and analyze the intraoperative state of calcaneal fractures, and summarize the law of displacement after calcaneal fractures, so as to guide fracture reduction and fixation. METHODS: From March 2002 to March 2009, among 572 patients with calcaneal fractures, 427 patients were male and 145 patients were female, ranging in age from 17 to 73 years, averaged 37 years. The patients were injured from falling or road accidents, and all the patients were closed fracture. The 189 patients with complete clinical data were treated with reduction and fixation through the lateral approach after observation of displacement type of the fractures. RESULTS: Among 189 patients,the fractures were found at the lower part of the articular surface in all patients, which was hillock point of calcaneus; the fractures were found at the Gissans Corner in 134 patients, and the type include cross-sectional fracture or oblique fracture; the fractures were found at calcaneal tubercle in 118 patients, and the fractures were divided into two parts from top to bottom; the fractures were found at the distal part of calcaneus only in 67 patients. CONCLUSION: Calcaneal fractures show clear law of dislocation. Preoperative and intra-operative detailed analysis and evaluation, as well as reduction and fixation according to certain sequences can insure to get better operative effects.

[Problems and solutions of plate internal fixation for the treatment of calcaneal fractures].

OBJECTIVE: To retrospective analysis operating procedures and results of calcaneal fractures treated with plate fixation, identify problems and propose measures to reduce surgical complications. METHODS: From June 2008 to April 2009, 156 patients were reviewed, including 121 males and 35 females, ranging in age from 18 to 59 years, with an average of 41 years. Thirty-two patients had bilateral calcaneal fractures. Twenty-three patients were surgically treated on both calcaneus at the same time. Total 179 calcaneus were treated with operation. The operation records of all patients were analyzed in order to find the problems and deficiencies. RESULTS: Among 179 calcaneal fractures, 31 feet (17.3%) had postoperative wound problems: wound infection and non-healing were found in 26 feet (14.5%), skin flap necrosis in 5 feet (2.8%). There were a lot of problems of plate internal fixation for the treatment of calcaneal fractures, including operation design, operative technique, as well as fracture reduction and fixation. CONCLUSION: The following methods are the only way to avoid operative complications for the treatment of calcaneal fractures: improved surgical technique, minimally invasive operation, simple and effective internal fixation.

[An imaging study on location of the anterior border of facets and the posterior border of vertebral bodies in lower cervical spine].

OBJECTIVE: To explore the location of the anterior border of facets and the posterior border of vertebral bodies in lower cervical spine,and to provide a quantitative data to evaluate the correct length of transarticual screws in lower cervical spine during procedure. METHODS: One hundred standard lateral X-ray films and fifty CT films on cervical spine were used to measure the distance of the anterior border of facets and the posterior border of vertebral bodies in lower cervical spine. HS, HM and HI were defined as parameters, which means the distance between the anterior border of the superior (HS), median (HM) and inferior (HI) part of facets and the posterior border of corresponding vertebral bodies. The value will be negative if the anterior border of the facet located before the vertebral body. RESULTS: 'HS > HM > HI' was found in all facets in lower cervical spine. The anterior border of the facet in C(3,4) located before the posterior border of the vertebral body of C3. The anterior border of C(4,5) and C(5,6) was inclined to posterior. The anterior border of C(6,7) located after the posterior border of the vertebral body of C6. The pattern of HS increased from C(3,4) to C(6,7), the minimal (0 +/- 0.25) mm and the maximal (2.91 +/- 1.05) mm. The tendency of HM raised from C(3,4) to C(6,7), the minimal (-1.57 +/- 0.53) mm and the maximal (1.54 +/- 0.39) mm. The pattern HI added from C(3,4) to C(6,7), the minimal (-2.03 +/- 0.40) mm and the maximal (1.08 +/- 0.70) mm. CONCLUSION: During the implantation of the transarticular screws, the tip of the screws should be 0-2 mm before the posterior border of the vertebral body of C3 at C(3,4), 0-2 mm after that of C4 at C(4,5), 0.5-2.5 mm at C(5,6) and 1-3 mm at C(6,7). The quantitative location between the anterior border of facets and the posterior border of the corresponding vertebral bodies can offer an indirect method to evaluate the correct length of transarticual screws in lower cervical spine during procedure.