Fenestration-poking Reduction and Internal Fixation for Comminuted Intra-articular Fracture of Calcaneus

Wang Kexue; Huang Li; Hu Yunzhou

Abstract：Objective To summarize the clinical efficacy of levering reduction and internal fixation for intra-articular comminuted calcaneal fractures. Methods From January 2008 to January 2014,seventy-seven feet with intra-article comminu-ted calcaneal frature were operated by the mean of levering reduction and internal fixation,they were 47 men and 21 women, with the age of 18 to 70 years old(average,39. 8 years). According to Essex-Lopresti's classification,49 feet were compres-sion-type Ⅱ and 4 feet were Ⅲ,9 feet were tongue-type Ⅱ and feet were Ⅲ. All patients were treated with levering reduction by the Kirschner wire(the function of the kirschner wire was similar to a level in the operation)and internal fixation with the calcaneal plate via the modified L-shape lateral approach,the bone healing and complications were followed up regularly. Re-sults All of the seventy-seven feet showed excellent results of reduction and fixation,but there were 3 feet who occurred the skin flap necrosis and slow healing of the incision. The patients were followed up for 1 to 6 years(average 1. 5 years),all of them healed in 4 to 7 months(average 5. 6 months). The operational efficacy was assessed by Mrayland Foot scoring system at the last follow-up. Mrayland foot scoring system showed excellent functional recovery in 21 feet,good in 43 feet,fair in 9 feet, and poor in 4 feet,giving an excellence to good rate of 83. 1% ,no plate loosening,shifting or broken occurred. Conclusion With the standard of Gissane and boholer angle,levering reduction the subtalar joint and maintaining the distance of calcaneus and astragalus,recovering the length、width and height of the calcaneus,modifying the varus and valgus deformity,and fixing the bone with the calcaneal plate at last is an efficient method to treat the displaced intra-anticular comminuted calcaneal frac-ture.