Extensile L-shaped lateral approach for displaced intra-articular calcaneal fractures

LI Pei-yuan; CHEN Hui; HUA Xiang; CHEN Guo-zou; CHEN Ze-zhuang; FENG Lin-wei; ZHANG Lian-yang

doi:10.3969/j.issn.1009-4237.2018.05.003

Abstract：Objective To investigate the effect of extensile L-shaped lateral surgical approach for displaced intra-articular calcaneal fractures(DIACF).Methods A retrospective review was made between Jan.2015 to Dec.2016.Ninety-seven patients(121 feet)with closed DIACF were included.Eighty-nine were males and 8 fe-males,with age ranging from 19 to 63 years(mean 37.0 years).The trauma causes included high fall injury in 70 cases,and traffic injury in 27 cases.Calcaneal fractures were classified according to the Sanders classification,43 feet were type Ⅱ,54 were type Ⅲand 24 were typeⅣ.Operations were performed 4-13 days after injury.All pa-tients presented extensile L-shaped lateral approach surgery.Information about wound complications and risk factors was recorded.Postoperative clinical outcome was evaluated according to the analysis of B ?hler's angle at final follow-up,and functional assessment was conducted using the Maryland foot score(MFS).Results There were 22 heels of wound complications,including dark skin in heel margin in 15 cases,skin flap necrosis in 4 heels,and infection in 3 heels.All incisions cured after antibiotics,wound dressing,or using vacuum sealing drainage,or filling antibiotic-impregnated cement.Multivariate logistic regression analysis showed that Sanders fracture type Ⅲ,Ⅳ and surgical timing of more than 1.5 h increased the wound complications incidence(odds ratio value >1,P<0.05).The fol-low-up period was from 10 to 18 months(mean 12.7 months).Radiological results were satisfying with postopera-tive B?hler angle improved at follow-up(P=0.000).Based on the MFS,79.3% of the patients had a good-to-ex-cellent clinical result.Sanders fracture type had significant influence on the functional postoperative outcome in