Comparative Study Of Therapeutic Effect In Poking And Open Reduction And Internal Fixation Treatment Of Calcaneal Fractures

Objective:Calcaneal fractures are the most common foot fracture(60%)and account for 2% of all fractures in the body.Approximately 75% involve the joint and are more complex to treat and repair.Calcaneal fractures occur when the calcaneal bone is subjected to a large energy injury,usually an axial load to the calcaneal bone such as a fall from a height or a traffic accident.In this study,we compared the efficacy,complications and time and economic costs of Chinese medicine prying and internal fixation methods in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures to provide a reference for the clinical selection of surgical procedures in the treatment of Sanders Ⅱ and Ⅲ calcaneal fractures.Methods:The cases of Sanders Ⅱ,Ⅲ calcaneal fractures admitted and treated with the above two methods in the foot and ankle second ward of Tianjin Hospital from January 1,2018,00:00 to January1,2020,00:00 were retrospectively analyzed.According to the uniform diagnostic criteria,inclusion criteria and exclusion criteria,40 cases were finally included,of which 20 cases were treated with Chinese prying repositioning kyphosis pin fixation(poking group)and 20 cases were treated with incisional repositioning internal fixation(ORIF group).The patients were followed up for more than 1 year after surgery,with an average duration of 14 months.The data were compiled and statistically analysed by combining the X-ray performance of the patients one year after surgery,the AOFAS scoring system to evaluate the foot function,counting the postoperative complications and reviewing the electronic medical records to obtain the patients’ operative time,intraoperative bleeding,hospitalization time,and total costs.Result:1.Among the 40 Sanders Ⅱ and Ⅲ calcaneal fractures studied,the differences between the poking group(20 cases)and the ORIF group(20 cases)in terms of age,gender and timing of treatment were not statistically significant(P>0.05)and were comparable.2.In Sanders Ⅱ calcaneal fracture: in terms of AOFAS ankle and hindfoot scores,postoperative excellent rate,imaging performance(Bohler angle,Gissane angle,posterior calcaneal height and its difference),there was no statistically significant difference between the poking group and the ORIF group at P>0.05;the two cases of incisional skin margin necrosis were both patients in the ORIF group,which was statistically significantly different.3.In the Sanders Ⅲ calcaneal fracture: P<0.05,statistically significant,for imaging performance and AOFAS score at 1 year postoperatively in the prying group compared to the ORIF group,with the ORIF group being significantly better than the poking group;one case of postoperative infection of the incision was in the ORIF group,a statistically significant difference.Conclusions:1.In Sanders Ⅱ calcaneal fracture,there was no significant difference in the reduction effect and excellent rate between the TCM poking and repositioning kerf fixation and the incision and repositioning internal fixation method,P>0.05.2.In Sanders Ⅲ calcaneal fractures,there was a statistically significant difference in the imaging performance and AOFAS scores at 1 year postoperatively between the TCM poking and repositioning kerf fixation and the incisional internal fixation method,with P<0.05.The incisional internal fixation method was significantly better than the TCM poking and repositioning kerf fixation method.3.The TCM poking and repositioning kerf fixation was significantly better than the incisional method of internal fixation in terms of intraoperative bleeding,operative time,hospitalization time and cost,and postoperative complications.