[Treatment of intra-articular calcaneal fractures with unilateral external fixator combined with limited internal fixation].

OBJECTIVE: To study the clinical effects of the unilateral external fixator combined with limited internal fixation such as cannulated lag screws for the treatment of intra-articular calcaneal fractures.

METHODS: From May 2007 to February 2012,52 patients (58 feet) with intraarticular calcaneal fractures were treated with unilateral external fixator and limited internal fixation such as lag screws. Forty-five patients (51 feet) were male,7 patients (7 feet) were female,ranging in age from 18 to 64 years,averaged 36.5 years. Time from injury to surgery was 4 to 13 (6.2 +/- 0.8) days. According to Sanders classification, there were 36 cases (40 feet) with type II fractures, 13 cases (15 feet) with type III fractures, 3 cases (3 feet) with type IV fractures. All patients were examed with X-ray and CT. Böhler angle, Gissane angle, length, width, height were measured on the radiographs, respectively. The function of the feet was assessed by the Maryland grading system.

RESULTS: Fifty-one patients(57 feet) were followed up for 5 to 16 months,with an average of 7.2 months. Calcaneal Böhler angle increased from (12.65 +/- 5.32) degrees preoperatively to (30.63 +/- 4.28) degrees postoperatively. The calcaneal Gissane angle decreased from (129.87 +/- 6.25) degrees preoperatively to (122.11 +/- 4.89) degrees postoperatively. The calcaneal length increased from (64.5 +/- 7.1) mm preoperatively to (71.3 +/- 5.7) mm postoperatively. The calcaneal width decreased from (34.6 +/- 5.7) mm preoperatively to (28.2 +/- 6.1) mm postoperatively. The calcaneal height increased from (30.2 +/- 5.2) mm preoperatively to (39.3 +/- 6.4) mm postoperatively. All of the comparison between preoperative and postoperative measurements revealed statistically significant (P < 0.05). The length,width, height, Böhler angle and Gissane angle were improved significantly (P < 0.05). According to the Maryland grading system, the result was excellent in 20 feet, good in 31 feet, fair in 4 feet, pour in 2 feet,excellent and good rate was 89.5%. Three feet with wound infection or flap necrosis were healed after wound debridement and dressing exchange.

CONCLUSION: The unilateral external fixation combined with limited internal fixation is a satisfactory treatment for intra-articular calcaneal fractures in short term with less damage, few complications and good functional recovery.