COMPARISON OF PERCUTANEOUS POKING REDUCTION FIXATION AND OPEN REDUCTION AND INTERNAL FIXATION FOR DISPLACED Sanders Ⅱ TYPE CALCANEAL FRACTURES_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

 SHALiangkuan , TIANJiaxiang , LIJingxiang , TIANZhenxing , LILixin

Department of Joint Surgery, Shandong Energy Zaozhuang Mining Group Center Hospital, Zaozhuang Shandong, 277800, P. R. China;

Corresponding author：

SHALiangkuan, Email: 1623935191@qq.com

Keywords：

Calcaneal fracture; Minimal invasion; Percutaneous poking reduction; Open reduction; Internal fixation

DOI：

10.7507/1002-1892.20150121

Video：

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Objective To compare the clinical results between percutaneous poking reduction fixation and open reduction and internal fixation for the displaced Sanders Ⅱ type calcaneal fractures. Methods A retrospective analysis was made on the clinical data of 122 patients with Sanders Ⅱ type calcaneal fractures between May 2007 and May 2012, who accorded with the inclusion criteria. The closed reduction and percutaneus Kirschner wire fixation were used in 61 patients (closed group), and open reduction and internal fixation were used in 61 patients (open group). There was no significant difference in gender, age, fracture side, weight, height, body mass index, the causes of injury, the fracture type, Böhler angle, Gissane angle, and the time from trauma to operation between 2 groups (P>0.05). The operation time, intraoperative blood loss, hospitalization days, wound complications, fracture healing time, American Orthopaedic Foot and Ankle Society (AOFAS) score, and radiographic results were compared between 2 groups. Results The operation time, intraoperative blood loss, and hospitalization days in closed group were significantly less than those in open group (P<0.05). There was no deep infections in both group; wound dehiscence, skin flap necrosis, and wound infection occurred in 3 patients, 2 patients, and 1 patient of the open group, no wound complication happened in closed group, and there was significant difference in the incidence of wound complications between 2 groups (P=0.027). The patients were followed up 24-68 months (mean, 38.7 months) in the closed group and 26-66 months (mean, 38.7 months) in the open group. There was no significant difference in the fracture healing time between 2 groups (t=-1.562, P=0.121). The Böhler angle and Gissane angle at last follow-up were significantly improved when compared with preoperative angle in the closed group (t=-27.929, P=0.000; t=-26.351, P=0.000) and the open group (t=-32.565, P=0.000; t=-25.561, P=0.000), but there was no significant difference between 2 groups (P>0.05). AOFAS score showed no significant difference between 2 groups (t=-0.492, P=0.624). Conclusion For the displaced Sanders Ⅱ type calcaneal fractures, the use of closed reduction and percutaneus Kirschner wire fixation or open reduction and internal fixation can both obtain satisfactory clinical function and radiographic results, but the former has the advantage of less trauma, shorter hospitalization time, and fewer wound complications.

Citation： SHALiangkuan, TIANJiaxiang, LIJingxiang, TIANZhenxing, LILixin. COMPARISON OF PERCUTANEOUS POKING REDUCTION FIXATION AND OPEN REDUCTION AND INTERNAL FIXATION FOR DISPLACED Sanders Ⅱ TYPE CALCANEAL FRACTURES. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(5): 558-562. doi: 10.7507/1002-1892.20150121 Copy

1.	杜玉喜, 刘年喜, 牛智慧. 解剖型接骨板内固定治疗跟骨关节内骨折. 实用骨科杂志, 2014, 20(6):563-564.
2.	Griffin D, Parsons N, Shaw E, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus:randomised controlled trial. BMJ, 2014, 349:g4483.
3.	Bajammal S, Tornetta P 3rd, Sanders D, et al. Displaced intra-articular calcaneal fractures. J Orthop Trauma, 2005, 19(5):360-364.
4.	Mcbride DJ, Ramamurthy C, Laing P. The hindfoot:Calcaneal and talar fractures and dislocations-Part I:Fractures of the calcaneum. Curr Orthop, 2005, 19(2):94-100.
5.	Rammelt S, Zwipp H. Calcaneus fractures:facts, controversies and recent developments. Injury, 2004, 35(5):443-461.
6.	Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg (Am), 2000, 82(2):225-250.
7.	张青山, 张蜀华. 两种手术治疗Sanders Ⅱ型、Ⅲ型跟骨骨折的比较. 实用骨科杂志, 2014, 20(6):515-519.
8.	Walde TA, Sauer B, Degreif J, et al. Closed reduction and percutaneous Kirschner wire fixation for the treatment of dislocated calcaneal fractures:surgical technique, complications, clinical and radiological results after 2-10 years. Arch Orthop Trauma Surg, 2008, 128(6):585-591.
9.	Zwipp H, Rammelt S, Barthel S. Calcaneal fractures-open reduction and internal fixation (ORIF). Injury, 2004, 35 Suppl 2:SB46-54.
10.	Harvey EJ, Grujic L, Early JS, et al. Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int, 2001, 22(11):868-873.
11.	Zwipp H, Tscherne H, Thermann H, et al. Osteosynthesis of displaced intraarticular fractures of the calcaneus:results in 123 cases. Clin Orthop Relat Res, 1993, (290):76-86.
12.	陈欣, 姜宏. 跟骨复位器配合克氏针撬拨治疗SandersⅡ型跟骨骨折46例. 实用骨科杂志, 2014, 20(7):657-659.
13.	Gavlik JM, Rammelt S, Zwipp H. Percutaneous, arthrosco-picallyassisted osteosynthesis of calcaneus fractures. Arch Orthop Trauma Surg, 2002, 122(8):424-428.
14.	Rammelt S, Gavlik JM, Barthel S, et al. The value of subtalar arthroscopy in the management of intra-articular calcaneus fractures. Foot Ankle Int, 2002, 23(10):906-916.
15.	Tornetta P 3rd. Percutaneous treatment of calcaneal fractures. Clin Orthop Relat Res, 2000, (375):91-96.
16.	Rammelt S, Amlang M, Barthel S, et al. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res, 2010, 468(4):983-990.
17.	Buch J. Bohrdrahtosteosynthese des Fersenbeinbruches. Akt Chir, 1980, 15:285-296.
18.	Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures:results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290):87-95.
19.	朱学敏. 跟骨骨折复位质量与疗效评价分析. 中国矫形外科杂志, 2014, 22(6):524-527.
20.	Basile A. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures in elderly patients. J Foot Ankle Surg, 2010, 49(1):25-32.
21.	陈兵乾, 盛晓文, 薛峰, 等. 外侧"L"形切口锁定接骨板治疗跟骨骨折. 实用骨科杂志, 2014, 20(3):273-275.
22.	Jiang N, Lin QR, Diao XC, et al. Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture:a meta-analysis of current evidence base. Int Orthop, 2012, 36(8):1615-1622.
23.	刘光磊, 张波涛, 王峥, 等. 梯形切口治疗跟骨关节内骨折手术技巧及优点. 实用骨科杂志, 2014, 20(3):283-284.
24.	王震. 小切口与"L"型切口治疗跟骨骨折疗效及并发症的对比研究. 中国矫形外科杂志, 2013, 21(14):1402-1405.
25.	Bruce J, Sutherland A. Surgical versus conservative interventions for displaced intra-articular calcaneal fractures. Cochrane Database Syst Rev, 2013, 1:CD008628.
26.	Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures:analysis of 190 fractures. J Orthop Trauma, 1999, 13(5):369-372.
27.	伍凯, 林健, 黄建华, 等. 扩大L型切口治疗闭合性跟骨骨折伤口并发症的相关因素分析. 上海交通大学学报:医学版, 2014, 34(7):1043-1048.
28.	Magnan B, Bortolazzi R, Marangon A, et al. External fixation for displaced intra-articular fractures of the calcaneum. J Bone Joint Surg (Br), 2006, 88(11):1474-1479.
29.	McGarvey WC, Burris MW, Clanton TO, et al. Calcaneal fractures:indirect reduction and external fixation. Foot Ankle Int, 2006, 27(7):494-499.
30.	于涛, 杨云峰, 俞光荣. 微创技术在治疗跟骨骨折中的应用进展. 中国修复重建外科杂志, 2013, 27(2):236-239.
31.	Pan A, Chatterjee D, Garg AK, et al. Percutaneous fixation of displaced intra-articular calcaneal fracture. J Indian Med Assoc, 2011, 109(6):412-414.
32.	Woon CY, Chong KW, Yeo W, et al. Subtalar arthroscopy and flurosocopy in percutaneous fixation of intra-articular calcaneal fractures:the best of both worlds. J Trauma, 2011, 71(4):917-925.

1. 杜玉喜, 刘年喜, 牛智慧. 解剖型接骨板内固定治疗跟骨关节内骨折. 实用骨科杂志, 2014, 20(6):563-564.
2. Griffin D, Parsons N, Shaw E, et al. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus:randomised controlled trial. BMJ, 2014, 349:g4483.
3. Bajammal S, Tornetta P 3rd, Sanders D, et al. Displaced intra-articular calcaneal fractures. J Orthop Trauma, 2005, 19(5):360-364.
4. Mcbride DJ, Ramamurthy C, Laing P. The hindfoot:Calcaneal and talar fractures and dislocations-Part I:Fractures of the calcaneum. Curr Orthop, 2005, 19(2):94-100.
5. Rammelt S, Zwipp H. Calcaneus fractures:facts, controversies and recent developments. Injury, 2004, 35(5):443-461.
6. Sanders R. Displaced intra-articular fractures of the calcaneus. J Bone Joint Surg (Am), 2000, 82(2):225-250.
7. 张青山, 张蜀华. 两种手术治疗Sanders Ⅱ型、Ⅲ型跟骨骨折的比较. 实用骨科杂志, 2014, 20(6):515-519.
8. Walde TA, Sauer B, Degreif J, et al. Closed reduction and percutaneous Kirschner wire fixation for the treatment of dislocated calcaneal fractures:surgical technique, complications, clinical and radiological results after 2-10 years. Arch Orthop Trauma Surg, 2008, 128(6):585-591.
9. Zwipp H, Rammelt S, Barthel S. Calcaneal fractures-open reduction and internal fixation (ORIF). Injury, 2004, 35 Suppl 2:SB46-54.
10. Harvey EJ, Grujic L, Early JS, et al. Morbidity associated with ORIF of intra-articular calcaneus fractures using a lateral approach. Foot Ankle Int, 2001, 22(11):868-873.
11. Zwipp H, Tscherne H, Thermann H, et al. Osteosynthesis of displaced intraarticular fractures of the calcaneus:results in 123 cases. Clin Orthop Relat Res, 1993, (290):76-86.
12. 陈欣, 姜宏. 跟骨复位器配合克氏针撬拨治疗SandersⅡ型跟骨骨折46例. 实用骨科杂志, 2014, 20(7):657-659.
13. Gavlik JM, Rammelt S, Zwipp H. Percutaneous, arthrosco-picallyassisted osteosynthesis of calcaneus fractures. Arch Orthop Trauma Surg, 2002, 122(8):424-428.
14. Rammelt S, Gavlik JM, Barthel S, et al. The value of subtalar arthroscopy in the management of intra-articular calcaneus fractures. Foot Ankle Int, 2002, 23(10):906-916.
15. Tornetta P 3rd. Percutaneous treatment of calcaneal fractures. Clin Orthop Relat Res, 2000, (375):91-96.
16. Rammelt S, Amlang M, Barthel S, et al. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res, 2010, 468(4):983-990.
17. Buch J. Bohrdrahtosteosynthese des Fersenbeinbruches. Akt Chir, 1980, 15:285-296.
18. Sanders R, Fortin P, DiPasquale T, et al. Operative treatment in 120 displaced intraarticular calcaneal fractures:results using a prognostic computed tomography scan classification. Clin Orthop Relat Res, 1993, (290):87-95.
19. 朱学敏. 跟骨骨折复位质量与疗效评价分析. 中国矫形外科杂志, 2014, 22(6):524-527.
20. Basile A. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures in elderly patients. J Foot Ankle Surg, 2010, 49(1):25-32.
21. 陈兵乾, 盛晓文, 薛峰, 等. 外侧"L"形切口锁定接骨板治疗跟骨骨折. 实用骨科杂志, 2014, 20(3):273-275.
22. Jiang N, Lin QR, Diao XC, et al. Surgical versus nonsurgical treatment of displaced intra-articular calcaneal fracture:a meta-analysis of current evidence base. Int Orthop, 2012, 36(8):1615-1622.
23. 刘光磊, 张波涛, 王峥, 等. 梯形切口治疗跟骨关节内骨折手术技巧及优点. 实用骨科杂志, 2014, 20(3):283-284.
24. 王震. 小切口与"L"型切口治疗跟骨骨折疗效及并发症的对比研究. 中国矫形外科杂志, 2013, 21(14):1402-1405.
25. Bruce J, Sutherland A. Surgical versus conservative interventions for displaced intra-articular calcaneal fractures. Cochrane Database Syst Rev, 2013, 1:CD008628.
26. Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures:analysis of 190 fractures. J Orthop Trauma, 1999, 13(5):369-372.
27. 伍凯, 林健, 黄建华, 等. 扩大L型切口治疗闭合性跟骨骨折伤口并发症的相关因素分析. 上海交通大学学报:医学版, 2014, 34(7):1043-1048.
28. Magnan B, Bortolazzi R, Marangon A, et al. External fixation for displaced intra-articular fractures of the calcaneum. J Bone Joint Surg (Br), 2006, 88(11):1474-1479.
29. McGarvey WC, Burris MW, Clanton TO, et al. Calcaneal fractures:indirect reduction and external fixation. Foot Ankle Int, 2006, 27(7):494-499.
30. 于涛, 杨云峰, 俞光荣. 微创技术在治疗跟骨骨折中的应用进展. 中国修复重建外科杂志, 2013, 27(2):236-239.
31. Pan A, Chatterjee D, Garg AK, et al. Percutaneous fixation of displaced intra-articular calcaneal fracture. J Indian Med Assoc, 2011, 109(6):412-414.
32. Woon CY, Chong KW, Yeo W, et al. Subtalar arthroscopy and flurosocopy in percutaneous fixation of intra-articular calcaneal fractures:the best of both worlds. J Trauma, 2011, 71(4):917-925.

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Chinese Journal of Reparative and Reconstructive Surgery

COMPARISON OF PERCUTANEOUS POKING REDUCTION FIXATION AND OPEN REDUCTION AND INTERNAL FIXATION FOR DISPLACED Sanders Ⅱ TYPE CALCANEAL FRACTURES

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