| Background:Calcaneus fracture is a common type of tarsal fracture.60%-65%ofall tarsal fracture cases are calcaneus fracture, and often causes damageon subtalar joint.Falls from heights, heavy impact on heel are the usualcauses of calcaneus fracture. Spongy bone is protected by a thin layer ofone sided bone cortex shell, calcaneus would fracture when astragalusexert downward impact on calcaneus. Post surgeries complications areusual because of the calcaneus’ special anatomical structure, low bloodsupply of surrounding soft tissue and strong impact on nearby tissues.Since calcaneus plays a crucial role in human walking andmaintaining body stability, it is of significant importance to handlecalcaneus fracture with great precision. In recent years, as the result ofintensive research on foot biomechanics and the rapid development ofmedical technology, the quality of treatment and prognosis have graduallyimproved. Various methods of surgeries are available depending ondifferent circumstances of the fracture, extensile lateral approach to openreduction and internal fixation method is now extensively applied, amongmany methods, lateral expansion of the "L" shape incision is relativelymore common. Post-surgery problems due to incision complicationsoccur significantly more frequent on calcaneus fracture than other type of fractures. Therefore, how to restore anatomical replacement as well asreduce incidence rate on calcaneus incision at the same time has nowbecome a major topic in calcaneus fracture treatment.Objective: To analyze the efficacy and complications after closedcalcaneal fracture surgery via a lateral L-shaped incision and find relatedfactors that may affect the efficacy.Method: A statistics analysis was used to deal with131cases (168feet)calcaneus fracture from June2009to October2013, there were104malesand27females with the mean age of40.5years(ranged18-70years), allcases were therapied by the L-shaped incision operation, analysis thesurgery complications and efficacy. All cases were made to unify thepreoperation and postoperative therapy. Classify the cases according tofracture type, preoperative preparation time, and the Bohler’s angle andGissane angle before and after operation, fellow up all patients from6month to52month, at an average of28.6month by postoperativeobservation and outpatient appointment. Use SPSS17.0to analysis thesuspect factors that lead to lateral L-shaped incision soft tissuecomplications after operation. P<0.05showed statistical differencesbetween with and without the suspect factors.Results: All131cases were followed up,28cases had the postoperativewound complications25of them the incision were healing after4weeksby anti-infection and dressing change and the others had the osteomyelitis and cured by filling Antibiotic bone cement and good fracture healing,34cases occurred traumatic arthritis. There were significant differencebetween the preoperative preparation time and incision complications,and the same with the Bohler’s angle and Gissane angle before and afteroperation. According to Maryland Foot Score, The excellence to goodrate was79.8%. The subtalar arthritis often appears in1-2years after theoperation，64.7%of the total. Half of the Sander IV occurred traumaticarthritis.Conclusion:1. Treatment of intra-articular calcaneal fracture with via alateral L-shaped incision can obtain good clinical outcomes.2. Topreoperative preparation time, we should avoid giving operation during8hours to7days. For type IV fractures, more than7days after injury isthe most secure time by surgical treatment.3. The Bohler’s angle andGissane angle are associated with the degree of calcaneus fracture，andthey play a great role in calcaneus shape recovery.4. The more severe ofcalcaneus fractures are, the lower of postoperative foot function scorewill be accordingly.5. Traumatic arthritis have a high risk forpostoperative Sanders IV. |
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