Comparison of Surgical Techniques for the Treatment of Intraarticular Calcaneal Fractures

Year 2019, Volume: 8 Issue: 2, 65 - 72, 01.05.2019

Mehmet Orçun Akkurt Vedat Biçici Özkan Öztürk İsmail Demirkale

https://doi.org/10.5505/abantmedj.2019.50490

Abstract

INTRODUCTION: Optimal treatment for displaced intraarticular calcaneal fractures is controversial. We aimed to compare the clinical and radiological results of minimal invasive and open surgeries for calcaneal fractures.METHODS: Patients with calcaneal fractures treated with surgery in the authors’ institutions in 2010-2015 were retrospectively reviewed. Patients were divided into two groups, open reduction and percutaneous fixation and subdivided into groups according to Sanders classification. Inversion-eversion range-of-motions were measured with a goniometer on the last follow-up. Functional assessment was done with American Foot and Ankle Society AOFAS ankle-hindfoot scale and Maryland foot scores MFS . Pain is assessed with a 10-cm VAS scale. Calcaneal height and width were measured both preoperatively and on the last follow-up. Complications were also assessed. RESULTS: 52 calcanei of 42 patients were treated with open reduction and 40 calcanei of 32 patients were treated with minimal-invasive surgery. Mean age for both groups were 35 and mean follow-up was 25.5 months. There are no statistically significant differences between two groups, in terms of age. Mean time to surgery from admission was 8.2 2-14 days in open reduction group and 2.5 1-5 days in percutaneous reduction group. There are no statistically significant differences between two groups, in terms of ROM, VAS, AOFAS and Maryland scores. Functional scores were better in Sanders 2 group than Sanders 3 group, free from surgical technique. Calcaneal height restoration is independent from the surgical technique. Calcaneal width is more restored by open reduction p=0.001 . There are 3 deep infections and 5 other wound complications in the open-reduction group while there were wound complications with minimal-invasive surgery.DISCUSSION AND CONCLUSION: Both treatment methods for calcaneal fractures end with similar clinical results but percutaneous fixation has advantages of early surgery and less complications. Sanders classification is prognostic.

Keywords

Calcaneal fracture, minimal-invasive, open

Eklem İçi Kalkaneus Kırıklarında Cerrahi Tekniklerin karşılaştırılması

Abstract

GİRİŞ ve AMAÇ: Ayrılmış eklem içi kalkaneus kırıklarının en uygun tedavisi tartışmalıdır. Bu çalışmada kalkaneus kırıklarında minimal girişimsel ve açık cerrahilerin klinik ve radyolojik sonuçlarının karşılaştırılması amaçlanmıştır.YÖNTEM ve GEREÇLER: Yazarların kurumlarında 2010-2015 yılları arasında kalkaneus kırığı nedeniyle ameliyat edilen hastalar geriye dönük incelenmiştir. Hastalar, açık yerine koyma ve perkütan tespit olarak ikiye ayrılmış, daha sonra bu gruplar da Sanders sınıflamasına göre kendi içlerinde alt gruplara ayrılmıştır. İnversiyon-eversiyon hareket açıklıkları son kontrolde gonyometre ile ölçülmüştür. Fonksiyonel değerlendirme Amerikan Ayak ve Ayak Bileği Cemiyeti AOFAS ayak bileği-ardayak skalası ve Maryland Ayak Skorlaması MFS ile yapılmıştır. Ağrı 10 cm görsel analog skala VAS ile değerlendirilmiştir. Kalkaneus yüksekliği ve genişliği hem ameliyat öncesinde hem de son control muayenesinde ölçülmüştür. Komplikasyonlar ayrıca değerlendirilmiştir.BULGULAR: 42 hastanın 52 kalkaneusu açık yerine koyma yöntemiyle, 32 hastanın 40 kalkaneusu minimal girişimsel teknikle ameliyat edilmiştir. Her iki grup için de ortalama yaş 35 olup ortalama takip süresi 25,5 aydır. Yaş yönünden iki grup arasında anlamlı bir fark yoktur. Başvurudan ameliyata kadar geçen süre, açık cerrahi için 8,2 2-14 gün, ve perkütan cerrahi için 2,5 1-5 gündür. ROM, VAS, AOFAS ve Maryland skorları açısından iki grup arasında anlamlı bir fark yoktur. Cerrahi teknikten bağımsız olarak, Sanders 2 grubunda Sanders 3 grubundan daha iyi fonksiyonel skorlar elde edilmiştir. Kalkaneus yüksekliği, cerrahi teknikten bağımsız olarak düzelmiştir. Kalkaneus genişliği açık cerrahi ile daha başarılı düzelmiştir p=0.001 . Açık redüksiyon grubunda 3 derin enfeksiyon ve 5 diğer yara komplikasyonu görülmüşken minimal girişimsel cerrahiyle bu komplikasyonlar görülmemiştir.TARTIŞMA ve SONUÇ: Kalkaneus kırıkları için her iki tedavi yöntemi de benzer klinik sonuçları sağlamıştır ama perkütan cerrahi ile daha erken ve daha az komplikasyonlu ameliyat avantajları mevcuttur. Sanders sınıflaması prognostik değer taşımaktadır.

Keywords

Kalkaneus kırığı, minimal invazif, açık

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