| Introduction:The importance of the ankle and foot have been given sufficient attention in the study of biomechanics calcaneus. It is also important to foot shape and mechanical stability as adequate, the lateral longitudinal arch of the common wall and the importance of the posterior lateral column. Talus and the three articular surface above the calcaneus constitute the subtalar joint complex, the relationship of their position and function maintain the subtalar joint movement and mechanical stability together. Subtalar joint is the important guarantee for the motor function of ankle and the rear foot,its injury wound be severe damage to the motor function of the rear foot. The latter part of is the principal focus of most of the weight articular surface,its changes of anatomical structure will lead to cartilage damage. The shape of calcaneus is also important, Its height and the length has a direct relationship to the normal joint spaces and the shape and stability of arch. Deformity will be a significant impact to power lines of rear foot and the function of joints, therefore, the biomechanical characteristics and the importance of the calcaneus decide the importance and high standards when we treat calcaneal fractures. Open reduction and internal fixation is the more direct way to recover the calcaneus fractures to normal anatomical structures. However, there has been a problem plaguing the application of calcaneal fractures open reduction and internal fixation, even that, a considerable number of orthopedic doctors take a conservative treatment to calcaneal fractures habitual when they will treat patients with calcaneal fractures. The problem is that incision will not heal and even infect after surgery of calcaneal fractures open reduction and internal fixation. There was a patient transferred to our hospital with postoperative infection because of falling leading to a case of calcaneus fractures in the beginning of the year 2007.We inhibited the further development of the infection After three months treatment in our hospital, but patient had lost function of both feet forever,and a large soft tissue had lost at the bottom of the foot, the wound did not heal for Long-term, finally Feet were amputated. In order to make the tragedy not be repeated, I had studied 146 feet (134 people) with calcaneal fractures since June 1998 -December 2008 in our hospital, comparative analysis them from a high degree of injury, tourniquet time, fracture type, timing of surgery etc in order to get the right time to take open reduction and internal fixation to treat calcaneal fracture.Objective: Through the decades, my hospital closed calcaneal fractures in patients with retrospective study, Come to how to choose the appropriate timing of operation, so that the application of open reduction and internal fixation in patients treated with postoperative infection and the incidence of osteomyelitis to a minimum.Methods: By retrospective analysis, we will examine the object in accordance with the fracture type, injury height, time after injury to surgery interval, gender, age, whether or not smoking and drinking, such as classification under the premise that before and after operation in a unified treatment, surgical procedures. All these patients were followed-up for 6 months to 10 years, with an average of 31 months, through the postoperative observation, patient referral and other means of communication, then, we have post-operative complications (infection and osteomyelitis) the incidence of statistical analysis.Results: From the operation time and postoperative complications analyzed surgery is the high incidence of postoperative complications in 3-7 days after injury, more than 10 days after injury, surgical treatment is the most safe, two days before and 8-10 after injury, surgical treatment is more safe. From the point of view the type of fracture, the incidence of postoperative complications of II, III fracture types was not significant, while type IV is the incidence of postoperative complications was significantly higher than the former two types of. From the injured high analysis: more than four meters high in the high incidence of postoperative complications, and lower the contrary. From the tourniquet time analysis: the patients who use it more than 70 minutes had a higher incidence of postoperative complications, on the contrary lower.Conclusion: The ultimate goal of this study is how to choose the best surgical timing of open reduction and internal fixation according to the patients with fractures of different types, the high degree of injury and other factors, under the strict control of tourniquet application time . Through the analysis of the factors mentioned above:1 Surgery time, 3-7 days after injury, not suitable for any type of fracture line open reduction and internal fixation.2 In the use of tourniquet time should not be more than 70 minutes.3 For type II fractures, if the injury is lower than 4.0 meters high, the patients can accepte Open reduction and internal fixation in two days before and 8-10 after injury. If the injury is higher than 4.0 meters high, then more than 10 days after injury, surgical treatment should be preferred.4 For type III fractures, more than 10 days after injury is the most secure time by surgical treatment , especially for the patients who had a high degree of injury is greater than 4.0 meters ,had no choice other operative time. For less than 4.0 meters high and injured patients, injury two days before and after 8-10 days after injury as a second choice.5 For type IV fractures, especially comminuted fracture, regardless of the high level of injury, should be selected for more than 10 days after injury further surgery. |
