Chinese Journal of Tissue Engineering Research ›› 2020, Vol. 24 ›› Issue (15): 2342-2348.doi: 10.3969/j.issn.2095-4344.2521

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Comparison of percutaneous reduction by leverage combined with minimally invasive internal fixation and “L” incision internal fixation in the treatment of calcaneal fracture  

Zheng Zhihui, Cai Peibiao, Guan Keli, Li Xiaowu, Zheng Xun, Chen Haibo, Zeng Qingqiang   

  1. Second Department of Orthopedics, Shantou Hospital of Traditional Chinese Medicine (Shantou Hospital Affiliated to Guangzhou University of Chinese Medicine), Shantou 515031, Guangdong Province, China
  • Received:2019-07-30 Revised:2019-08-02 Accepted:2019-09-02 Online:2020-05-28 Published:2020-03-22
  • Contact: Zeng Qingqiang, Master, Chief physician, Second Department of Orthopedics, Shantou Hospital of Traditional Chinese Medicine (Shantou Hospital Affiliated to Guangzhou University of Chinese Medicine), Shantou 515031, Guangdong Province, China
  • About author:Zheng Zhihui, Master, Associate chief physician, Second Department of Orthopedics, Shantou Hospital of Traditional Chinese Medicine (Shantou Hospital Affiliated to Guangzhou University of Chinese Medicine), Shantou 515031, Guangdong Province, China Cai Peibiao, Master, Attending physician, Second Department of Orthopedics, Shantou Hospital of Traditional Chinese Medicine (Shantou Hospital Affiliated to Guangzhou University of Chinese Medicine), Shantou 515031, Guangdong Province, China Zheng Zhihui and Cai Peibiao contributed equally to this study.

Abstract:

BACKGROUND: Intra-calcaneal fractures involving subtalar joints account for about 75% of all calcaneal fractures. Surgical treatment of displaced intra-articular calcaneal fractures is superior to non-surgical treatment. However, the timing of treatment, surgical indications, incision selection, and bone grafting are still controversial. The classical “L” approach is gradually replaced by minimally invasive internal fixation because of its high incision complications.

OBJECTIVE: To compare the clinical effect of minimally invasive internal fixation and “L” incision for the treatment of Sanders II and III calcaneal fractures. 

METHODS: Sixty patients with Sanders II or III calcaneal fractures from January 2016 to January 2019 in the Second Department of Orthopedics, Shantou Hospital of Traditional Chinese Medicine were randomly divided into minimal invasion group (n=32) and “L” incision group (n=28). The patients in the minimal invasion group and “L” incision group received percutaneous reduction by leverage combined with minimally invasive internal fixation and “L” incision internal fixation treatment, respectively. At 6 months after operation, the curative effect of the two groups was evaluated according to the American Orthopedic Foot and Ankle Society score. Preoperative waiting days, the operation time, the length of stay and the complication incidence were compared between the two groups. Böhler angle and Gissane angle were measured and compared preoperatively, postoperatively and during the final follow-up.

RESULTS AND CONCLUSION: (1) The excellent and good rate of American Orthopedic Foot and Ankle Society score was 91% in the minimal invasion group and 93% in the “L” incision group (P > 0.05). (2) The postoperative Böhler angle and Gissane angle were significantly improved in both groups (P < 0.05). At postoperative 1 day, Gissane angle of two groups was equivalent (P > 0.05). Böhler angle was better in the “L” incision group than in the minimal invasion group (P < 0.05). At the final follow-up, both groups had different degrees of decrease in Böhler angle and Gissane angle (P > 0.05). (3) The preoperative waiting days and the length of stay were longer in the “L” incision group than those in the minimal invasion group (P < 0.05). The operation time was shorter in the “L” incision group than in the minimal invasion group (P < 0.05). (4) The incidence of complications was lower in the minimal invasion group (9%) than in the “L” incision group (32%) (P < 0.05). (5) Compared with the traditional “L” incision open reduction and internal fixation, the treatment of Sanders II and III calcaneal fractures with percutaneous reduction by leverage combined with minimally invasive internal fixation are satisfactory, with less trauma and complications. It is worth being recommended in clinic.

Key words:

calcaneal fracture, Sanders II, III,  , percutaneous reduction by leverage, minimally invasive internal fixation, “L” incision

CLC Number: