Morphological Analysis Of Calcaneal Bone And Risk Factors Of Perioperative Complications Of Calcaneal Fracture

Calcaneus is an important weight-bearing part of the lower limbs.It is the basis and support for the foot to bear the body weight.It participates in the formation of varus / valgus joints and is the insertion points of Achilles tendon and other ligaments.It is of great significance for the body to walk,stand and maintain balance.At the same time,the anatomical structure of calcaneus is relatively complex,irregular bone,which is the largest of the seven tarsals.It forms the heel with talus.The soft tissue covering the calcaneus is relatively thin.It has four joint surfaces,one in the front and forms the calcaneocuboid joint at the junction of cuboid bone;three in the upper,the anterior,middle and posterior joint surfaces,and the posterior articular process as the main load-bearing surface,contact with talus to form subtalar joint,which allows foot varus and valgus.Calcaneal fracture is a common foot injury in orthopedics and emergency department.It accounts for about 2% of all fractures and 50-60% of tarsal fractures.It is mostly caused by axial high-energy injuries,such as falling from height and traffic accidents,which mainly occurs in men engaged in production and labor.If the treatment is not appropriate,it is easy to cause long-term pain and dysfunction of the foot.At present,calcaneal fracture is still one of the most complex fractures that orthopedics doctors deal with.Because of the complex fracture types and the limited surrounding soft tissue cover,how to successfully obtain long-term functional rehabilitation after treatment is a difficult problem.Similarly,the prevention of complications related to calcaneal fractures is very important for the thorough treatment of calcaneal fractures.For the treatment of calcaneus,I carried out the morphological research of calcaneus,epidemiological investigation of calcaneal fracture,and identified the common complications of calcaneal fracture were postoperative infection and preoperative deep vein thrombosis,and carried out the risk factors research of related complications.To provide data reference and theoretical basis for the treatment of calcaneal fracture.Part one The morphological analysis of calcaneusObjective: The calcaneus is the largest bone in the foot and provides the basis for the other tarsals and metatarsals.The aim of this paper is to study the morphology of calcaneus and to provide theoretical basis for the treatment of calcaneus fracture.Methods: In this study,we collected the lateral X-ray films of normal feet and ankles from the PACS system of the Imaging Center of the Third Hospital of Hebei Medical University from September 2018 to December2018,and selected the subjects according to the inclusion and exclusion criteria.Demographic characteristics such as age,gender and profile of each examiner were extracted.Anatomical data measurement software of the lateral calcaneal X-ray "nine-point diagram" was used to measure the Bohler Angle,Gissane Angle,calcaneocuboid articular plane inclination,posterior articular plane inclination,Fuller Angle,calcaneal compression Angle,and calcaneal height of each examiner.Shapiro-Wilk test was used to analyze the normality of continuous variables,and two-sample T test or Mann-Whitney U test was used to compare demographic indicators between different genders.According to the normal condition,Pearson correlation analysis or Spearman correlation analysis was used to analyze the correlation between the parameters.Results: A total of 378 images of eligible subjects were included,including 160 females and 218 males.The overall mean age was 42.29±13.71 years old(20-82 years old).There were statistical differences in Gissane Angle,calcaneocuboid surface inclination Angle,Fuller Angle and calcaneal height between male and female groups,and only in the lateral section of Fuller Angle.In women,age was significantly correlated with Gissane Angle,Bohler Angle,posterior articular plane inclination,and calcaneus compression Angle.The height of calcaneus was significantly correlated with Bohler Angle,posterior articular plane inclination Angle,calcaneus compression Angle and calcaneus axis length.In men,age was significantly correlated with Gissane Angle,Bohler Angle,calcaneocuboid plane inclination,posterior articular plane inclination,calcaneal compression Angle,calcaneal height,and calcaneal axis length.The height of calcaneus was significantly correlated with age,Gissane Angle,Bohler Angle,posterior articular plane inclination,calcaneal compression Angle,and calcaneal axis length.Conclusion: In this study,the calcaneus parameters of normal Chinese were systematically studied and the normal range of 8 morphological parameters was determined.The reliability and repeatability of parameter measurement are good.There were gender differences in 5 morphological parameters,but no gender differences in all morphological parameters.Among female examiners,four parameters were significantly related to age.Among male examiners,seven parameters were significantly associated with age.This study provides theoretical basis and data support for the morphological study of calcaneus.To find out the influence of gender and age factors on calcaneal morphological parameters,and provide guidance for the design and development of calcaneal internal fixators,calcaneal fractures,and the diagnosis and treatment of calcaneal diseases.Part two Epidemiological analysis of calcaneal fracture and its complicationsObjective: Calcaneal fracture is a common and complex type of bone fracture in orthopedic surgery.Failure to receive proper treatment can result in long-term disability and severe economic burden on society and individuals.The purpose of this study is to study the epidemiological characteristics of calcaneal fractures and their complications and to provide reference for the treatment and prevention of complications of calcaneal fracturesMethods: a prospectie study discovers,from October 1,2014 to December 31,2018,in the hebei medical university third hospital patients with calcaneal fractures,collect and record the demographic characteristics,including gender,age,related information,for at least 1 year of follow-up after surgery,ask and check the cases of shallow surgical site infection,surgical site infection,preoperative traumatic arthritis,double lower limbs deep vein thrombosis,sural nerve damage,phil side tenosynovitis and other complications.The gender and age distribution characteristics of calcaneal fractures were analyzed and compared,and the distribution of complications of calcaneal fractures was combed.Results: A total of 914 patients(1044 sides)with calcaneal fracture were treated during the study period,including 375 unilateral left side,409 simple right side,and 130 bilateral.Male accounted for the majority of calcaneal fractures,about 91.76%,and the ratio of male to female was about11.1:1.Overall,the high incidence age of calcaneal fracture was 31 to 35 years old,the high incidence age of male patients was 31 to 35 years old,accounting for 17.32% of male patients,and the high incidence age of female patients was 46 to 50 years old,accounting for 15.12% of female patients.The three complications with high morbidity were superficial infection at the surgical site 6.80%,deep infection at the surgical site 3.54%,and preoperative deep vein thrombosis 4.31%.Conclusion: There are significant differences in the incidence of calcaneal fracture between men and women.Young and middle-aged men(26to 55 years old)are more likely to have calcaneal fracture(85.59%),while there is no significant difference in women of different ages.Surgical site infection and preoperative deep vein thrombosis of lower limbs are common complications of calcaneal fracture.Part Three Incidence and risk factor for preoperative deep vein thrombosis(DVT)in isolated calcaneal fracture,a prospective cohort study Backgrounds: Deep vein thrombosis(DVT)occurring during the preoperative waiting period may affect the prognosis of traumatic patients,but there still lack of relevant data.This study aimed to address the preoperative DVT in isolated calcaneal fractures.Methods: Patients who presented with isolated calcaneal fracture and received preoperative Duplex ultrasound scanning of bilateral lower extremities for detection of DVT between October and December 2018 were eligible for inclusion.Relevant data were prospectively collected,including demographics,comorbidities,lifestyles,injury,and laboratory biomarkers at admission.Univariate analyses were used to compare the difference of each variable between patients with and without DVT.Multivariate logistics regression analysis was used to identify the independent risk factors for DVT.Results: Totally,770 patients met the criteria and were included,and 24(3.1%)had preoperative DVT diagnosed at mean of 5.3 days after injury,all of which were asymptomatic.Among patients with DVTs,36 thrombi were found and29(80.6%)were in distal veins.Eight patients had DVTs in multiple veins,but no patients had bilateral DVTs.The multivariate analyses showed older age(?58 vs <58 years,OR = 3.84),delay from injury to DUS(in each day,OR = 1.23)and elevated plasma D-dimer level(?1.79 vs <1.79 mg/L,OR =2.53)were independent risk factors associated with DVT.Conclusions: Due to low prevalence of DVT in isolated fracture,routine throboprophylaxis is not recommended.However,emphasis should be given in older patients with delay to admission and elevated plasma D-dimer level for targeted detection of DVT and rapid therapeutic intervention.Part Four Incidence and risk factors for deep surgical site infection(DSSI)after open reduction and internal fixation(ORIF)of calcaneal fractures: a prospective cohort study of 1044 subjectsObjective: Calcaneal fractures are the most prevalent complex fractures in the fracture clinic.There are still a myriad of challenges that must be overcome in the treatment of calcaneal fractures,especially postoperative deep surgical site infection(DSSI).Currently,there is a paucity of data regarding DSSI.Therefore,we herein aimed to explore the characteristics of DSSI after open reduction and internal fixation(ORIF)in calcaneal fractures,as well as to identify potential factors associated with DSSI.Methods: We conducted a prospective study of 914 patients with 1044 calcaneal fractures who were treated with ORIF at a level 1 trauma center between October 2014 and December 2018.All patients with complete data were followed for at least one year.We then collected patient demographics,comorbidities,lifestyles,injury-related data,preoperative laboratory biomarkers,and operative-related data.We employed univariate test and multivariate logistics regression analysis to identify the independent risk factors for DSSI.Results: Overall,1044 calcaneal fractures from 914 patients met the inclusion/exclusion criteria(130 bilateral).We found that 3.5%(thirty-seven wounds)developed DSSI within the follow-up period.Notably,patients with DSSI exhibited a marked longer average hospital stay compared to those without infection(31.76 vs 17.52 days,respectively).The results of multivariate analysis revealed the following independent risk factors of postoperative DSSI: higher BMI(? 28.4)(OR,4.43;95% CI,1.87 to 10.48;P = 0.001),ipsilateral tibia fracture(OR,4.89;95% CI,1.47 to 16.20;P =0.009),Gustilo and Anderson classification type II(OR,14.02;95% CI,4.70 to 41.86;P < 0.001),Gustilo and Anderson Classification Type III(OR,60.37;95% CI,14.04 to 259.56;P < 0.001),and longer preoperative stay(> 11 days)(OR,2.69;95% CI,1.21 to 5.93;P = 0.015).Conclusion: The findings from this study demonstrate that the incidence of DSSI is relatively low(3.5%).We further identified four significant risk factors associated with calcaneal fractures treated with ORIF.To reduce the risk of post-operative DSSI,we hereby recommend that efficient and personalized preoperative management strategies should be guaranteed to reduce the interval from injury to surgery,particularly for patients with higher BMI,ipsilateral tibia fracture,or more severe Gustilo and Anderson fracture types.