COMPARISON OF THREE OPTIONS FOR TREATMENT OF CALCANEAL FRACTURE

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Abstract

Until now the problem of selecting a conservative or operative treatment option for calcaneal fractures and moreover the choice of the most optimal surgical procedure for such lesions have not been solved. Thus, comparative studies in this area is one of the most important tasks of the modern traumatology.

 Purpose of the study — to compare treatment outcomes, pattern and complications rate following the use of three treatment options for calcaneal fractures.

 Material and Methods. The authors analyzed treatment outcomes of 95 patients from 2013 till 2016. Mean age of patients was 39.04±12.51 years. Patients were divided into three groups: group 1 consisted of 41 patients with 54 fractures who underwent functional conservative treatment; group 2 consisted of 18 patients with 22 fractures treated by open reduction and plate fixation; group 3 consisted of 36 patients with 40 fractures treated by minimally invasive reduction and intramedullary fixation. Groups did not differ in respect of risk factors rate and rate of surgical risks under ABCDEF scale. Outcomes were evaluated basing on roentgenological criteria of reduction, complications rate and the functional scales FFI (Foot Function Index) and LEFS (Lower Extremity Functional Score).

 Results. Mean follow up was 20.8±9.0 months. Catamnesis was controlled in 68 out of 95 patients (71.6%). Variances were observed for all criteria of reduction quality between group 1 (no reduction) and groups 2 and 3. Groups 2 and 3 demonstrated similar criteria in respect of reduction quality of posterior articular surface, restoration of height and axis of calcaneus (р>0.05). FFI and LEFS scores in group 1 were inferior to results in groups 2 and 3 (р<0.05) at 6 and 12 months follow up. At 24 months follow up the variances persisted for mean values but were not statistically significant (р>0.05). No differences between groups 2 and 3 were observed during all follow up terms (р>0.05). Sum rate of complications in wound healing in group 2 was significantly higher than in groups 1 and 3 (р = 0.033).

 Conclusion. Any of the described options of surgical treatment resulted in an earlier functional restoration after calcaneal fractures as compared to conservative treatment. Reduction quality and late functional outcomes did not vary between the study groups, however, the rate of complications for wound healing in the group with open internal fixation was higher.

About the authors

V. O. Kalensky

Sklilfosovsky Clinical and Research Institute for Emergency Care.

Author for correspondence.
Email: fake@neicon.ru

Vsevolod O. Kalensky — scientist of Polytrauma Department.

3, Bolshaya Sukharevskaya pl., 129090, Moscow.

Россия

P. A. Ivanov

Sklilfosovsky Clinical and Research Institute for Emergency Care.

Email: fake@neicon.ru

Pavel A. Ivanov — Dr. Sci. (Med.), head of Polytrauma Department.

3, Bolshaya Sukharevskaya pl., 129090, Moscow.

Россия

F. A. - K. Sharifullin

Sklilfosovsky Clinical and Research Institute for Emergency Care.

Email: fake@neicon.ru

Faat A.- K. Sharifullin — Dr. Sci. (Med.), chief researcher of CT and MRI Department.

3, Bolshaya Sukharevskaya pl., 129090, Moscow.

Россия

O. A. Zabavskaya

Sklilfosovsky Clinical and Research Institute for Emergency Care.

Email: fake@neicon.ru

Olga A. Zabavskaya — Cand. Sci. (Med.), senior scientist of CT and MRI Department.

3, Bolshaya Sukharevskaya pl., 129090, Moscow.

Россия

References

  1. Mitchell M.J., McKinley J.C., Robinson C.M. The epidemiology of calcaneal fractures. Foot (Edinb). 2009; 19:197-200.
  2. Исламбеков У.С., Халиков Р.А., Оманов М.Э. Причины нетрудоспособности и инвалидности при переломах пяточной кости. Ортопедия, травматология и протезирование. 1991;(8):63-66.
  3. Crosby L.A., Fitzgibbons T. Computerized tomography scanning of acute intra-articular fractures of the calcaneus. A new classification system. J Bone Joint Surg Am. 1990;72(6):852-859.
  4. Kitaoka H.B., Schaap E.J., Chao E.Y., An K.N. Displaced intra-articular fractures of the calcaneus treated non-operatively. Clinical results and analysis of motion and groundreaction and temporal forces. J Bone Joint Surg Am. 1994;76(10):1531-1540.
  5. Buckley R.E., Tough S., McCormack R., Pate G., Leighton R., Petrie D., Galpin R. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2002; 84-A(10):1733-1744.
  6. Agren P.H., Wretenberg P., Sayed-Noor A.S. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2013;95(15):1351-1357. doi: 10.2106/JBJS.L.00759.
  7. Griffin D., Parsons N., Shaw E., Kulikov Yu., Hutchinson C., Thorogood M., Lamb S.E. Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial. BMJ. 2014;349:g4483. doi: 10.1136/bmj.g4483.
  8. Коробушкин Г.В. Оптимизация лечения больных с повреждениями костей стопы: автореф. дис. д-ра мед. наук. М., 2015. 50 с.
  9. Соколов В.А., Федосов А.П., Шарифуллин Ф.А. Особенности лечения повреждений заднего отдела стопы у пострадавших с политравмой. Вестник травматологии и ортопедии им. Н.Н. Приорова. 2008;(1):7-11.
  10. Radnay C.S., Clare M.P., Sanders R.W. Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter? J Bone Joint Surg Am. 2009;91(3):541-546. doi: 10.2106/JBJS.G.01445.
  11. Thermann H., Hüfner T., Schratt H.E., Held C., Tscherne H. Subtalar fusion after conservative or surgical treatment of calcaneus fracture. A comparison of long-term results. Unfallchirurg. 1999;102(1):13-22. (in German).
  12. Benirschke S.K., Kramer P.A. Wound healing complications in closed and open calcaneal fractures. J Orthop Trauma. 2004;18(1):1-6. doi: 10.1097/00005131-200401000-00001.
  13. Zwipp H., Rammelt S., Barthel S. Calcaneal fractures - open reduction and internal fixation (ORIF). Injury. 2004;35(Suppl 2):SB46-54. doi: 10.1016/j.injury.2004.07.011.
  14. Kumar S.V., Marimuthu K., Subramani S., Sharma V., Bera J., Kotwal P. Prospective randomized trial com-paring open reduction and internal fixation with mini-mally invasive reduction and percutaneous fixation in managing displaced intra-articular calcaneal fractures. Int Orthop. 2014;38(12):2505-2512. doi: 10.1007/s00264-014-2501-0.
  15. Голубев Г.Ш., Дубинский А.В. Cравнительная оцен-ка результатов оперативного лечения пациентов с импрессионными переломами пяточной кости. Травматология и ортопедия России. 2013;(2):63-71. doi: 10.21823/2311-2905-2013--2-63-71.
  16. Wallin K.J., Cozzetto D., Russell L., Hallare D.A., Lee D.K. Evidence-based rationale for percutaneous fixation technique of displaced intra-articular calcaneal fractures: a systematic review of clinical outcomes. J Foot Ankle Surg. 2014;53(6):740-743. doi: 10.1053/j.jfas.2014.03.018.
  17. Hammond A.W., Crist B.D. Percutaneous treatment of high-risk patients with intra-articular calcaneus fractures: a case series. Injury. 2013;44(11):1483-1485. doi: 10.1016/j.injury.2013.01.033.
  18. Sanders R., Gregory P. Operative treatment of intra-articular fractures of the calcaneus. Orthop Clin North Am. 1995;26:203-214
  19. Essex-Lopresti P. The mechanism, reduction technique, and results in fractures of the os calcis. Br J Surg 1952; 39: 395-419.
  20. Zwipp H., Tscherne H., Wulker N. Osteosynthese dislozierter intraartikulärer calcaneusfrakturen. Unfallchirurg. 1988;91:507-515.
  21. Кононова К.Ю., Глухов Д.В., Бердюгин К.А., Челноков А.Н. Наш опыт лечения внутрисуставных переломов пяточной кости. Фундаментальные исследования. 2014;10(Часть 2):294-297.
  22. Tornetta P. 3rd. The Essex-Lopresti reduction for calcaneal fractures revisited. J Orthop Trauma. 1998;12(7):469-473.
  23. Kurozumi T., Jinno Y., Sato T., Inoue H., Aitani T., Okuda K. Open reduction for intra-articular calcaneal fractures: evaluation using computed tomography. Foot Ankle Int. 2003;24(12):942-948. doi: 10.1177/107110070302401214.
  24. Xia S., Lu Y., Wang H., Wu Z., Wang Z. Open reduc-tion and internal fixation with conventional plate via L-shaped lateral approach versus internalfixation with percutaneous plate via a sinus tarsi approach for cal-caneal fractures­ – a randomized controlled trial. Int J Surg. 2014;12(5):475-480. doi: 10.1016/j.ijsu.2014.03.001.
  25. Rammelt S., Amlang M., Barthel S., Gavlik J.M., Zwipp H. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res. 2010;468(4):983-990. doi: 10.1007/s11999-009-0964-x.
  26. Mattiassich G., Litzlbauer W., Ponschab M., Ortmaier R., Rodemund C. Minimally invasive treatment of intra-articular calcaneal fractures with the 2-point distractor. Oper Orthop Traumatol. 2017;29(2):149-162. doi: 10.1007/s00064-016-0478-0.

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