Cannulated screw fixation for dislocated fractures of the calcaneus

S. Ivanov
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引用次数: 2

Abstract

Introduction Fractures of the calcaneus still remain some of the most challenging injuries that an orthopedic surgeon should manage. The difficulties about these fractures arise from the specific anatomy of the region, from the unique shape and morphology of the bone, and from the mechanism of the injury (in most cases high energy trauma). Despite the progress of the medical implants that can be used for fracture fixation in the last decade there are a lot of controversies, regarding the best option. Aim The aim of the study is to present our experience with the use of cannulated screws for fixation of dislocated fractures of os calcis. Materials and Methods Twenty patients with dislocated fractures of os calcis using cannulated screws for fixation were operated on for a period of two years (2017-2018). The classifications used in the study included: the Essex-Lopresti x-ray classification modified by Stulik and Stehlik and the CT classification of Sanders. Two of the patients were with dislocated extraarticular fractures of tuber calcanei, three patients with `extreme beak` type fractures, the remaining 15 patients were with intraarticular fractures with more than 2 mm step off in the subtalar joint: 9 patients with tongue type and 5 patients with joint depression type. Gender distribution: 18 men, 2 women. Results Evaluation of the results was made by using the Maryland Foot Score. Satisfaction from the treatment was graded using the Visual Analogue Scale (VAS) score (mean 7,5). The reduction is evaluated by measurement of the angle of Gissane, Bohler and Preis pre- and postoperatively. Assessment of the calcaneal height, length and width was initiated on lateral, axial and Broden views. Conclusion Fixation of displaced calcaneal fractures by cannulated screw is effective and reliable method. These screws are introduced by stab incisions which leads to minimal soft tissue dissection in such complex area of the hindfoot. It is an enormous advantage for fracture healing and reduces the percentage of possible complications.
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跟骨骨折仍然是骨科医生应该处理的最具挑战性的损伤之一。这些骨折的困难来自于该区域的特殊解剖结构,骨骼的独特形状和形态,以及损伤的机制(在大多数情况下是高能创伤)。尽管近十年来医用植入物在骨折固定方面取得了进展,但关于最佳选择仍存在许多争议。目的本研究的目的是介绍我们使用空心螺钉固定骨钙脱位骨折的经验。材料与方法对20例骨钙脱位骨折患者(2017-2018年)采用空心螺钉固定。本研究采用的分类包括:由Stulik和Stehlik修正的Essex-Lopresti x线分类和Sanders的CT分类。其中跟骨结节关节外骨折脱位2例,“极端喙”型骨折3例,距下关节内骨折间距大于2mm 15例,舌型9例,关节凹陷型5例。性别分布:男性18人,女性2人。结果采用马里兰足部评分法对结果进行评价。使用视觉模拟量表(VAS)评分对治疗满意度进行评分(平均7,5)。通过术前和术后测量Gissane、Bohler和Preis的角度来评估复位情况。评估跟骨高度,长度和宽度开始在侧位,轴位和阔登视图。结论空心螺钉固定移位跟骨骨折是一种有效、可靠的方法。这些螺钉是通过刺伤切口引入的,这使得在后足复杂区域的软组织剥离最小。这对骨折愈合来说是一个巨大的优势,并减少了可能的并发症的百分比。
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