Treatment Outcomes Of Complex Calcaneal Fracture By Modified External L-shaped Approach And Internal Fixation

Objective To study treatment outcome of 35 cases of intraarticular calcaneal fractures treated by modified external L-shaped incision and locking anatomical titanium plate fixation and to observe its long term result.Methods A retrospective analysis of clinical data from 31 patients(35 feet)with displaced intraarticular calcaneal fracture,who has been treated with open reduction and internal fixation through a modified lateral L-shaped approach from August 2014 to August 2016.There were 23 males,8 females,11 left feet,16 right feet and 4 bipedal,with an average age of 41.2�12.42years(range 24-70 years).The Gissane angle,B?hler angle,calcaneus height and calcaneus width were measured before and after operation in all the patients.Functional recovery was assessed using the American Foot and Ankle Surgery Association(AOFAS)hindfoot scoring system and Maryland Foot Score.Results The study included 31 patients(35 feet).All the patients were followed up for 12 to 24 months(average 16.4 months).Gissane angle,B?hler angle,calcaneus height and calcaneus width Before and after surgery were compared by t test.The differences was statistically significant(P < 0.05).At the last follow-up,the excellent and good rates of AOFAS hindfoot score and Maryland footscore were 91.4% and94.3% respectively.One patient had developed superficial necrosis at the skin margins.required only local wound care.Conclusion Careful patient selection in displaced intraarticular calcaneal fractures treated with open reduction and internal fixation through a modified lateral L-shaped approach in experienced hands,The complication rate was low,The curative effect is more affirmative.It is important to note that the level of surgical complications is closely related to the experience of the surgeon.The recovery of calcaneus height,calcaneus width,Gissane angle and B?hler angle are vital.Otherwise,severe limited motion of the subtalar joint may occur.