Mid-Term Results Of Surgical Treatment Of Intraarticular Displaced Calcaneal Fractures

Year 2010, Volume: 4 Issue: 1, 245 - 250, 21.03.2010

Serhan Ünlü

Abstract

In this study, we wanted to evaluate the diagnosis and the results of surgical interventions of patients with intraarticular calcaneal fractures retrospectively.
40 calcaneal fractures of 36 patients who were operated between May 2006 and April 2008 were included in the study. 32 of the fractures were because of falling from a high place, 3 of them were because of out-of-car traffic accidents and 1 of them was the result of articular sprain. Mean age of patients of whom 30 were men and 6 women was 42 (16- 71). Patients were pre and post operatively controlled with radiographs at which böhler and gissane angles were evaluated. Foot functions of patients and pain was evaluated with AOFAS scoring. Open reduction with lateral extensil locked plate approach and internal fixation with screws was performed on all patients on 7th day.
Mean follow up period was 15 months. Any problem with bone healing has not been experienced with any fractures. Superficial necrosis at the edges of incisions was detected at 4 patients (11%). Superficial or deep infection was not encountered in any patient. Reflex sympathetic dystrophy developed at 7 fractures of 5 patients (18). While böhler angle was normal at 4 of 40 feet before surgery, gissane angles were normal at 6 feet. At 30 of 36 feet (83%) böhler angle and 27 of 34 feet (79%) gissane angle was corrected to normal limits. Mean AOFAS score was found to be 81. Appropriate timing, proper technique and appropriate rehabilitation at especially sanders type 2 and 3 fractures, surgical treatment gives satisfactory results.

Keywords

calcaneus, fracture, surgical treatment

Eklem İçi Ayrılmış Kalkaneus Kırıklarının Cerrahi Tedavisinin Orta Dönem Sonuçları

Abstract

Bu çalışmada ayrılmış eklem içi kalkaneus kırığı tanısı ile cerrahi tedavi uygulanan hastaların sonuçlarını geriye dönük olarak değerlendirmeyi amaçladık.
Kliniğimizde Mayıs 2006 ile Nisan 2008 tarihleri arasında cerrahi uygulanan 36 hastanın 40 kalkaneus kırığı çalışmaya dahil edildi. Kırıkların 32 tanesi yüksekten düşme, 3 tanesi araç dışı trafik kazası ve 1 tanesi de burkulma sonucu idi. 30’u erkek 6’sı kadın olan hastaların ortalama yaşı 42 idi (16-71). Hastaların ameliyat öncesi, sonrası ve kontrollerinde radyografi ile böhler ve gissane açıları değerlendirildi. AOFAS skorlaması ile hastaların ayak fonksiyonları ve ağrısı değerlendirildi. Tüm hastalara ortalama 7. günde lateral ekstansil yaklaşım ile açık redüksiyon ve özel kilitli kalkaneus plak ve vidaları ile internal fiksasyon uygulandı.
Hastalar ortalama 15 ay takip edildi. Hiçbir kırıkta kaynama ile ilgili problem yaşanmadı. 4 hastada (%11) cilt keşişinin kenarlarında yüzeysel nekroz saptandı. Hiçbir hastada yüzeysel veya derin enfeksiyona rastlanmadı. 5 hastanın 7 kırığında refleks sempatik distrofi gelişti (%18). 40 ayağın 4’nde cerrahi öncesi böhler açısı normal iken, 6’sında gissane açıları normal olarak ölçüldü. 36 ayağın 30’unda (%83) böhler, 34 ayağın 27’sinde (%79) gissane açıları normal sınırlarda düzeltildi. Ortalama AOFAS skoru 81 olarak bulundu.
Özellikle sanders tip 2 ve 3 kırıklarda uygun zamanlama, uygun teknik ve uygun rehabilitasyon ile cerrahi tedavi tatminkar sonuç vermektedir.

Dr. Serhan Ünlü,
Dr. Birol Tunç,
Dr. Tuğhan Kalkan,
Dr. Çetin Işık,
Dr. Mehmet Akif Teber, Dr. Murat Bozkurt

Keywords

alkaneus, kırık, cerrahi tedavi.

References

• 1. Gausewitz S, Hohl M. The significance of early motion in the treatment of tibial plateau fractures. Clin Orthop 1986;202:135-138.
• 2. Stannard JP, Wilson TC, Volgas DA, Alonso JE. The less invasive stabilization system in the treatment of complex fractures of the tibial plateau: short-term results. J Orthop Trauma 2004;18:552-558.
• 3. Resnic D, Niwoyama G. Diagnosis of Bone and Joint Disorders. Philadelphia: WB Saunders Co, 1981
• 4. Rasmussen PS. Tibial condyler fractures. Impairment of knee joint stability as an indication for surgical treatment. J Bone Joint Surg (Am) 1973;55:1331-1350.
• 5. Aksoy B, Öztürk K, Olcay E, Kara AN, Alpay A, Basic B. Plato tibia kırıklarının cerrahi tedavisi. Acta Orthop Traumatol Ture 1995;29:133-5.
• 6. Lee AJ, Papadakis SA, Moon C, Zalavras CG. Tibial plateau fractures treated with the less invasive stabilisation system. International Orthopaedics (SICOT) 2007;31:415-418.
• 7. Tscherne H, Lobenhoffer P. Tibial plateau fractures: management and expected results. Clin Orthop 1993;292:87.
• 8. Hohl M. Treatment methods in tibial condylar fractures. South Med J 1975;68:985.
• 9. Bennett WF, Browner B. Tibial plateau fractures: a study of associated soft tissue injury. J Orthop Trauma 1994;8:183.
• 10. Colletti P, Greenberg H, Terk MR. MR findings in patients with acute tibial plateau fractures. Comput Med Imaging Graph 1996;20:389-94.
• 11. Gür B, Akman Ş, Aksoy B, Tezer M, Öztürk İ, Kuzgun Ü. Tibia plato kırıklarının cerrahi tedavisi. Açta Orthop Trau Turc 2003;37:113-119.
• 12. Hohl M, Moore TM. Articular fractures of the proximal tibia. In: Evarts M, editor. Surgery of the musculoskeletal system. 1st ed. New York: Lippincott; 1983. p. 111-34.
• 13. Itokazu M, Matsunaga T. Arthroscopic restoration of depressed tibial plateau fractures using bone and hydroxyapatite grafts. Arthroscopy 1993;9:103.
• 14. Krettek C, Gerich T, Miclau T A minimally invasive medial approach for proximal tibial fractures. Injury 2001;32(S3):4-13.