Affiliation:
1. Sklilfosovsky Clinical and Research Institute for Emergency Care.
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.
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