| Objective:To evaluate retrospectively the technical points and efficacy of minimally invasive internal fixation assisted with temporary LRS(limb reconstruction system)-based external fixation for intraarticular calcaneal fractures through the collection and analysis of the clinical data of 34 cases of closed intra-articular calcaneal fracturesMethods:In this retrospective study,from June 2016 to April 2018,34 cases of closed intra-articular calcaneal fractures in 30 patients admitted to the department of orthopedic trauma of southern hospital affiliated to southern medical university were treated with Minimally invasive internal fixation for intraarticular calcaneal fractures assisted with temporary LRS external fixation.Preoperative and postoperative X-ray and CT scans were performed to determine the Sanders classification of calcaneal fractures,and preoperative and postoperative calcaneal length,height,width,Bohler's angle(joint Angle of calcaneus tuberosity)of the calcaneus and the mechanical axis of the hindfoot.Preoperative and postoperative outcomes are compared and analyzed.Two weeks,one month,two months,three months,six months and one year after surgery,the patients were followed up by outpatient or telephone,postoperative complications were recorded,and the function of the affected Foot was scored by the American Orthopaedic Foot and Ankle Society(AOFAS)Ankle and Ankle Foot scoring system.Results:32 fractures in 28 patients were available for follow-up.There were 25 males and 3 females,aged from 21 to 60 years(average 43.56 ± 10.37 years old).According to the Sanders classification,17 cases were classified as type II,9 as type III and 6 as type IV.Of them,the left foot was affected in 18 cases and the right in 14.Their follow-ups averaged 20.66 ± 5.55 months(from 12 to 32 months).At the last follow-up,the AOFAS ankle/hind foot score averaged 85.3,the results were excellent in 7 cases,good in 20 cases,fair in 4 cases and poor in 1 case.Twenty patients achieved a normal or slightly restricted range of motion of the ankle joint after surgery,only one needed crutches to walk.There were significant improvements in the mean Bohler's angle[preoperative 8.65 ± 17.03°(from-26.05° to 40.00°)versus postoperative 21.57±9.63 °(from-6.31 ° to 46.50°)],mean height of the calcaneus[preoperative 41.11±5.84 mm(from 24.00 to 52.30 mm)versus postoperative 47.61±3.62 mm(from 36.10 to 56.10 mm)],mean length of the calcaneus[preoperative 76.98±6.93 mm(from 58.40 to 90.10 mm)versus postoperative 80.29±5.86 mm(from 70.00 to 93.20 mm)],mean width of the calcaneus[preoperative 47.66±5.98 mm(from 36.40 to 61.70 mm)versus postoperative 40.92±5.80 mm(from 31.90 to 58.30 mm)],and mean valgus angle of the hindfoot[preoperative 4.23 ± 0.54 °(from 3.12 ° to 5.37°)versus postoperative5.46±0.47°(from 3.87° to 6.20°)](all P<0.05).The operation time averaged 81.68±15.69 minutes(from 63 to 121 minutes),and the mean hospital stay 13.6 days.All the fractures healed with no postoperative soft tissue necrosis or deep infection.Localized short-term osteoporosis was observed in 6 patients,which responded to symptomatic therapy 5 months later.One patient experienced numbness on the soles that did not affect gait or walking function.Conclusions:For intraarticular calcaneal fractures,minimally invasive surgery assisted with temporary LRS external fixation can maximally reconstruct the calcaneal shape and the subtalar articular surface,while avoiding the soft tissue complications often associated with traditional lateral L-shaped incisions.This simple surgical protocol is suitable for complicated calcaneal fractures,especially Sanders types ? and ? calcaneal fractures.Besides,it provides a feasible treatment method for other surgeons to treat calcaneal fractures. |
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