Evaluate The Efficacy A-v Impulse Pump In The Treatment Of Calcaneal Fractures Soft Tissue Swelling Before Open Reduction Internal Fixation Operation

Objective: Calcaneal fractures are usually caused by high-energy traumatic event, such as fall from a height(ladder、rooftop and windowsill) or collision accidents(when the auto impact in collision accident accelerator pedal or brake pedal crash hindfoot result in calcaneal fractures). In addition occur in a mechanism involving powerful twisting of a foot or improper landing(such as athletes-ski jumpers, skiers, climbers, acrobats). Fractures of calcaneal always make other problems, such as verterbral compression fracture, femoral neck fracture, pelvic and acetabular fracture, tibial plateau fracture and ligament injuries and so on. The patients suffered from Calcaneal fractures usually underwent surgery, while the one with slightly joint surface dislocation were treated by closed purcutaneous reduction with leverage. The patients with severe joint face defect were underwent open reduction internal fixation operation because of the weakness tissue surrounding the calcaneus, the swollen state accounted for the high energe trauma. In the case of the incision breakdown after surgery, postoperative infection, the surgery should be delay for 8~19 days normally and 2~3 weeks at length. The study was to observe and record the preoperative swollen tissue of Calcaneal fracture after A-V impulse pump, analysis the clinical improvement in such process and provide the clinical reference data for medical work.Methods: 15 case of calcaneal fractures from January 2013 to January 2015 in the third hospital of Hebei Medical University were selected as research subjects(classified by Sanders IIIAB, IIIAC,IIIBC and IV). All patients were underwent open reduction internal fixation operation. The patients were divided into experimental group(A group) and control group(B group) randomly. The patients in A group were intervened by physical treatment by A-V impulse pump(4 times/day, 1 h/times), while the patients in B group elevate dysfunctional limb to decrease the swollen tissue. The clinical improvement of swollen tissue and postoperative incision direction: observe the swollen tissue of dysfunctional limb in two group each day before surgery by the ruffle experiment, record the time from the trauma to surgery,compare the differences of time in two groups and explore the statistics significant. Meanwhile, the postoperative incision direction was recorded which the one with slight exudation and red skin was considered to superficial injection,the one with incision breakdown complicated with purulence exudation was considered to deep infection. The surgery process: The patients in A and B group underwent open reduction internal fixation operation which the first incision initiated at the 1.5cm above the lateral malleolus along with the middle point of line which was connected lateral malleolus and Achilles tendon and the incision ended at the junction of lateral skin of foot and metatarsal bones. Moreover, from the ended point of first incision turn to the lateral fifth metatarsal bones horizontally and the whole shape of incision was similar as “L”. Then turn the lateral skin of metatarsal bones up, expose the surgery vision with peroneal muscular elevated. Reset the fracture with No-touch technology, fix the bone with metatarsal bone reconstruction plate.Results: The patients treated by A-V impulse pump to decrease the swollen tissue was taken 4~6 days(mean 5.44±0.73 days) before surgery. The patients treated by elevation of dysfunction limb to decrease the swollen tissue was taken 4~10 days(mean 7.83±2.04 days) before surgery. All differences of swollen decrease in two groups showed significant changes(P<0.05). In A group, 1 patient was superficial injection which was Staphylococcus infection defined by drug sensitive test, it was sensitive to vancomycin. In B group, 1 patient was superficial injection which was baumanii infection defined by drug sensitive test, it was sensitive to Cefoperazone and Sulbactam. The 2 patients were treated by antibiotic injection and physiotherapy without deep infection.Conclusions: The A-V impulse pump can treat swollen tissue surrounding the Calcaneal fractures effectively, securely, simply and thus can decrease the time preparing for surgery without incision complications after surgery. It was a better treatment to decreasing swollen tissue.