Percutaneous Reduction And Screw Internal Fixation For The Treatment Of Calcaneal Fractures Clinical Efficacy Analysis

BACKGROUND: Calcaneal fractures account for about 2% of total body fractures.It is the most common fracture of the patella in the clinic.About 75% of all calcaneal fractures are displaced intra-articular fractures.The mechanism of calcaneal fractures is usually caused by axial loads caused by falls or road traffic accidents.The calcaneus plays an important role in the body’s walking and maintaining the stability of the body,so it is very important to treat the fracture of the calcaneus reasonably and accurately.However,due to the special anatomy of the calcaneus,irregular shape,poor blood flow around the soft tissue,impact of high energy during fracture,and traction of the surrounding ligaments,often lead to poor skin conditions around the soft tissue,and it is difficult to treat.There are more postoperative complications.With the deepening of people’s understanding of calcaneal fractures and the advancement of medical technology,in order to improve the quality of life of patients,in addition to Sanders type I fractures,most advocate surgery.The main goal of surgical treatment is to achieve anatomic reduction and stable internal fixation of the subtalar articular surface in order to maintain the shape of the calcaneus,and then allow early joint function exercises to prevent post-traumatic arthritis.There are many surgical procedures,including open reduction and internal fixation,percutaneous reduction and internal fixation,limited open internal fixation,external fixation,arthroscopic assistive technique,arthrodesis,and percutaneous balloon dilation Surgery and so on.Among them,open reduction and internal fixation(ORIF)is one of the most classical surgical methods for the treatment of intra-articular fractures of the calcaneus.An inverted "L" type incision is made on the lateral side of the calcaneus.However,this traditional surgical method has its obvious disadvantages.The most important of these is the high incidence of wound complications and skin necrosis.Minimally invasive surgery is the direction that people try hard to achieve.It is hoped that the minimally invasive technique can both restore the anatomical relationship of the calcaneus and reduce the incidence of complications of calcaneal fractures.OBJECTIVE: To analyze the postoperative efficacy and related complications of percutaneous alveolar reduction and screw internal fixation for the treatment of calcaneal fractures,and to evaluate its clinical efficacy in the treatment of calcaneal fractures.METHODS: Retrospective analysis was used to select 43 patients with calcaneal fractures of 47 cases treated in our hospital from April 2015 to November 2017.Among them,8 were females and 35 were males,aged 20-73 years,mean 45.1 years old.Sanders II 27 feet,Sanders III 18 feet,2 feet for the tongue fracture in the Essex-Lopresti classification.Fractures were treated with percutaneous reduction and internal fixation with screws(2 patients with foot supplemented with a small incision in the sinus tarsi),and postoperative imaging data,clinical efficacy and functional scores were analyzed.During perioperative period,the same treatment was applied to the affected foot,and preoperative examinations were performed to collect the type of fracture of the patient,the interval from the injury to the operation,the B?hler angle and the Gissane angle before and after the operation.Through outpatient review and telephone follow-up from 3 months to 31 months,an average of 15.8 months.According to the American Orthopaedic Foot and Ankle Society(AOFAS)ankle and hindfoot scoring system,the function of the affected foot(50 points),pain(40 points),and on-line(10 points)were evaluated.100 points;of which 90 to 100 points are excellent,80 to 89 points are good,70 to 79 points are available,and <70 is poor.Analysis was performed using SPSS 17.0 statistical software.The data were expressed as mean ± standard deviation,using paired t-test;test level α = 0.05,when P <0.05,there was statistical significance.Results: 43 patients with 47 feet were followed up.The time is 3-30 months,with an average of 13.5 months.Bony union was obtained in all patients.All incisions healed by first intention,no skin necrosis,no complications such as nail tract infection,osteomyelitis,etc.;1 patient had skin necrosis after admission for 2 weeks after wounding.heal.At the final follow-up,the angles of B?hler and Gissane angles were all in the normal range,and there were significant statistical changes in preoperative and postoperative B?hler and Gissane angles.At the last follow-up,AOFAS palsy and hindfoot scores ranged from 54 to 100 points with an average of 87.4 points,of which 21 feet were excellent,19 feet were good,5 feet were good,and 2 feet were poor.The excellent and good rate was 85.11%.During the follow-up period,all patients had no screw exit,fracture,no reduction of reduction and repositioning of the fracture,4 patients had traumatic arthritis,and 2 patients experienced pain from long-distance walking due to protrusion of the lateral wall of the calcaneus and distal impact of the humerus..The hospital stay was 4-17 days with an average of 5.2 days.Conclusions: 1.Percutaneous reduction and screw internal fixation for the treatment of calcaneal fractures can restore the B?hler and Gissane angles of the calcaneus through the reduction and resetting of the calcaneal articular surface.2.Screw internal fixation for the treatment of calcaneal fractures can avoid the occurrence of soft tissue complications such as skin necrosis and incision infection;3.The incidence of traumatic arthroscopic knee osteoarthritis also increases with the severity of calcaneal fractures;4.Short hospitalization time,Less trauma,lower cost,faster postoperative recovery.