30 years experience in articular fractures of the calcaneus bone]

Results of 150 (123 in males, 27 in females) articular fractures of the calcaneus treated by various methods over period of 30 years have been evaluated. Mean age of the patients was 43 years. Minimum follow-up was 18 months. An analysis of the material indicates the need for reduction in every case. Westhues method is suitable for tongue type fracture, joint depression type should be managed by Palmer's method. Best results have been achieved after K-wire fixation of the reduced fracture and early mobilization. In fractures with no displacement or with a minor one functional treatment led to good results also. Unreduced fractures gave poor results; pain below lateral ankle was produced by compression of peroneal tendons with deformed calcaneus. Seventy per cent of the results were rated good, 15% fair and 15% poor.     

重建钢板塑形治疗距下关节内跟骨骨折

从2000年2002年，对距下关节内跟骨骨折，采用切开复位、重建钢板塑形内固定治疗31例，疗效满意，现总结如下。     

切开复位人工骨移植异形钛板内固定治疗跟骨关节内骨折

[目的]探讨跟骨关节内骨折切开复位人工骨填充加钛板内固定手术的治疗效果及优、缺点。[方法]2005年1月～2007年5月,对Sanders分型Ⅱ型以上的跟骨关节内骨折17例19足,男15例18足,女2例2足;年龄19～67岁,平均37.5岁,左侧9例,右侧6例,双侧2例,于伤后5～7d行跟骨外侧切口切开复位撬顶复位人工骨填充加异形钛板内固定手术。[结果]17例19足中,15足切口一期愈合;3足切口边缘血运不良,有渗液,对症治疗后愈合;1足切口渗液经换药治疗愈合。随访时间10～38个月,平均随访19.7个月。无1例感染,骨折平均愈合时间为2.5个月。术后3个月植入人工骨全部吸收。分别在术前、术后跟骨侧位及轴位X线片和CT片上测得Bhler角,跟骨的宽度及轴长,各指标的差异有统计学意义(均P0.01)。[结论]切开复位人工骨移植加异性钛板内固定是治疗跟骨关节内粉碎性骨折的有效治疗方法。需要注意手术技巧及术后治疗上的几个要点。     

跟骨关节内骨折的手术治疗

目的 总结应用跟骨解剖型钢板治疗跟骨关节内骨折的临床效果。方法 回顾分析1999年1月～2003年9月治疗的82例跟骨骨折的病例，所有患者手术前后均行常规的X线检查和CT半冠状位扫描，根据骨折粉碎情况和移位程度决定治疗的方法。其中Sanders分型Ⅲ型36例和Ⅳ型9例，共有45例采用外侧L型切口跟骨解剖型钢板内固定手术治疗。结果 45例患者应用跟骨解剖型钢板内固定手术基本恢复跟骨的高度、长度和宽度，术后切口感染3例，经治疗切口愈合。4例患者术后明显的距下关节炎，行二期跟距关节融合术。平均随访38个月，根据美国足踝外科协会跟骨骨折的评分标准，优6例、良26例、可7例、差6例。优良率达71.1％。结论 应用跟骨解剖型钢板治疗Sanders Ⅲ型、Ⅳ型跟骨关节内骨折，可以恢复跟骨的大体形态，能够获得较好的临床治疗效果。     

Follow-up evaluation of open intra-articular fractures of the calcaneus

The results of a follow-up evaluation of open intra-articular calcaneal fractures are presented. A modified Merle d’Aubigné functional score and Zwipp radiographic score were used. A retrospective analysis of 35 patients with 36 open intra-articular fractures represents the basis of the study. At the time of follow-up examination (on average 44 months after the injury), 5 amputations of the affected extremity and 4 ankle arthrodeses had been carried out. The 23 patients still able to bear weight on the affected hindfoot and possessing a functional ankle joint were radiographically and functionally evaluated. No excellent results were documented. Only 6 good functional and 2 good radiographic outcomes were noted. In 17 instances, a poor functional or radiographic score was given. Devastating results were seen in the course of treatment of third-degree open joint depression or comminuted intra-articular fractures (n = 15): 9 cases of osteomyelitis, 5 amputations, 1 partial calcanectomy, 1 arthrodesis. An open reduction as part of the primary treatment (n = 6) led to local complications in all instances. The most favorable results were seen after nonoperative fracture management: complication-free course of treatment in 4 of 11 patients. All workmen’s injuries led to a permanent disability, and these patients received compensation. The treatment and salvage of the soft-tissue envelope should be paramount in all therapeutic decisions. The fracture treatment must not further jeopardize these tissues. An aggressive operative treatment of local complications, including arthrodesis or amputation, is recommended. Received: 13 June 1996     

AIIogeneic bone nail for articular fractures

Objective: To investigate the effect of allogeneic bone nail on articular fractures.Methods: Ninety-one patients with cancellous bone fracture involved in various joints were fixed with the bone nail or the bone screw. No immunosuppressive agent was used in this series. The average period of follow-up was 18months.Results: All patients except one healed without displacement and the healing time was within 1-3 months.Joint function was partially limited in 6 patients and others were functioning well. Conclusions: Allogeneic bone nail possesses a good biological compatibility and intensity, thus provides a rigid fixation. Being completely absorbed and ossificated, thus obviating the need for secondary operation, is a suitable internal fixation material for the treatment of articular fractures.     

Allogeneic bone nail for articular fractures

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Long-term results of treatment for articular calcaneus fractures with Westhues method]

In this paper the authors evaluate the long-term results of treatment for articular calcaneus fractures with Westhues method. This evaluation is performed with regard to triple measurement of B?hler's angle value and to subjective criteria. The clinical material from years 1985-2002 consists of 47 patients aged between 24 and 56 years (mean age 32 years) with articular calcaneus fractures--namely, 41 male patients (87.2%) and 6 female patients (12.8%). The follow-up examination was performed in 24 patients (51% of all patients), namely, in 23 male patients (48.8%) and in one female patient (2.2%). Minimum follow-up time was 12 months and maximum was 9 years. Acquired results suggest that Westhues method restores normal B?hler's angle value only in tongue-type calcaneous fractures.     

A new perspective on management of open calcaneus fractures

The treatment protocol of closed calcaneal fractures has been described in the literature extensively. However, treatment of open calcaneal fractures has not been discussed in detail. Various treatment alternatives have been suggested including external fixator, primary subtalar distraction arthrodesis, and partial calcanectomy according to the type of fracture. We have retrospectively reviewed 36 adult patients with 39 open calcaneal fractures who were treated with our new philosophy. Average follow-up time was 9.29 years (range, 1.25-28 years). The American Orthopaedic Foot and Ankle Society (AOFAS) scoring system was used in functional evaluation. The average score was 77.9 (range, 67-92). All of the patients had limited subtalar movement. We propose an algorithm for the management of open calcaneus fractures, although treatment largely depends on the physical status of the patient, type of the fracture, localisation of the open wound and the surgeon's choice.     

Internal architecture of the calcaneus: implications for calcaneus fractures

STUDY DESIGN: Fourteen cadaveri specimens were sectioned to analyze the internal architecture of the human calcaneus. We described the arrangement and orientation of trabecular patterns within the calcaneus and made multiple measurements of its cortical thickness. OBJECTIVE: To characterize the internal architecture of the calcaneus and correlate these findings with well-described patterns of calcaneus fracture in order to better understand the fracture mechanics of this common fracture. METHODS: Fourteen dry, frozen, human calcanei were sectioned using a saw. In each the coronal, sagittal and axial planes, we sectioned separate specimens into slices of 0.5 mm thickness. High-resolution radiographic images were taken of the sectioned specimens. The internal trabecular arrays were described and measurements of cortical thickness were recorded. The correlation between these findings and the known pattern of calcaneal fractures was analyzed. RESULTS: A dominant trabecular pattern running antero-posteriorly along the long axis of the calcaneus was observed. In the posterior tuberosity the trabeculae were arranged parallel to the posterior border. There was an area of sparse or absent mineralization in the anterior part of the calcaneus corresponding to the "neutral triangle" described by Wood and Harty 10, 23. The thickest sites of the calcaneal cortex were the lower pole of the posterior tuberosity, the upper surface at the angle of Gissane, and the lateral surface below the anterior portion of the posterior facet. CONCLUSION: The trabecular architecture of the calcaneus is created by applied stress in concordance with Wolff's law. The weakest plane of resistance to stress is parallel to these organized trabeculae or through areas lacking trabeculae. This study demonstrates that the primary and secondary fracture lines commonly encountered in calcaneus fractures correlates with the internal architectural map of the calcaneal trabecular patterns.     

Functional outcome of patients following open reduction internal fixation for bilateral calcaneus fractures

Treatment of displaced intra-articular calcaneus fractures has historically been controversial, but recent developments have led to resurgence in open reduction internal fixation (ORIF) for displaced calcaneus fractures. Recent functional outcome studies comparing operative to nonoperative treatment of unilateral calcaneus fractures has shown a trend towards improved function with ORIF. No studies have investigated the functional outcome of patients who have required operative treatment of bilateral displaced calcaneus fractures. The purpose of this study was to review our operative experience with bilateral displaced intra-articular calcaneal fractures. A retrospective review of medical charts indicated 13 patients had undergone ORIF for bilateral calcaneus fractures. Nine patients could be contacted and brought to the clinic for functional evaluation and radiographic CT studies. Functional outcome was assessed by the Musculoskeletal Functional Assessment Score (MFA) and the American Orthopaedic Foot and Ankle Hindfoot Score (AOFAS). The average follow-up was 56 months. Over half of the patients required additional surgeries. The average MFA and AOFAS scores were 31.1 and 71.8, respectively. Functional outcome decreased for patients with multiple traumatic fractures and surgical procedures of the calcaneus. Our results show a diminished functional outcome for patients sustaining bilateral calcaneus fractures treated with ORIF when compared to patients managed surgically for unilateral calcaneus fractures, but better functional outcomes than patients who do not undergo ORIF for unilateral calcaneus fractures. This diminished function limits work capacity and ability to perform daily activities that require standing.     

跟骨关节内骨折内固定疗效分析

目的探讨跟骨关节内骨折切开复位内固定治疗的临床效果。方法对59例跟骨关节内骨折患者（76足）经跟骨外侧L形切口解剖型跟骨钢板内固定治疗,术前术后进行放射学评估,术后1年临床评估采用Maryland足部评分系统。结果 59例均获随访,时间6-36（24±10.5）个月。患者B hler角与Gissane角均恢复至正常范围。足部评分：优38足,良24足,中11足,差3侧,优良率为81.6%。结论掌握好手术指征和手术时机,解剖复位,早期功能锻炼,切开复位内固定治疗跟骨关节内骨折可以取得满意的疗效。     

Hindfoot arthrodesis for management of bone loss following calcaneus fractures and nonunions

Massive bone loss following calcaneal fractures is a challenging condition to treat, especially if nonunion is present. Meticulous preoperative examination and imaging are crucial for accurate preoperative planning. If?performed, successful outcomes can be achieved with the strategies outlined in this article.