개방성 종골 골절의 수술적 치료 결과

Abstract

Purpose: By reporting the operative treatment results of the calcaneal open fracture performed by our clinics, we would like to pay more attention to the calcaneal open fracture, contribute to continuous data collection, and help us understand appropriate treatment and realistic outcomes. Materials and Methods: Study was conducted retrospectively for 22 cases out of 30 patients who visited the our hospital from February 2009 to December 2019, which were followed up for more than 1year. In the classification of open fractures, the classification was carried out in accordance with Gustilo-Anderson classification and was evaluated with the soft tissue status at the time of patient’s visit. In all intra-articular calcaneal fractures, the fracture was classified using Sanders classification. Radiological parameters were measured for Böhler angle, Gissane angle, calcaneal length, height and width at before and after surgery, last follow-up. Clinical outcomes were evaluated by AOFAS ankle-hindfoot scale and investigated complications. Results: In the classification of open fractures, type IIIA was the most common with 10 cases(45%) and Sanders type III was the most common with 11 cases(50%). Of the total 22 cases after operation, 15 cases(68%) had complications, 11 cases(55%) had post-traumatic arthritis, 8 cases(36%) had infection, and 4 cases(18%) had both cases. Only Sanders classification was statistically significant in correlation with the incidence of posttraumatic osteoarthritis (P-value 0.004). In addition, for Sanders classification, the risk of developing posttraumatic osteoarthritis increased by a factor of 4.57 as the type of fracture became more severe in classification (P-value 0.035), which was statistically significant. In 18 cases(82%), the first stage of surgical treatment was performed, and minimally invasive surgery was performed using K-wires, Steinmann pins, and cannulated screws. The AOFAS ankle-hindfoot scale conducted for clinical evaluation on the final follow-up was averaged 72.5 points (41-88). Conclusion: In the treatment of open calcaneal fractures, internal fixation by minimally invasive approach showed relatively radiologically and clinically satisfactory results. However, follow-up research is expected to be required, including the results of long-term follow-up through large number of cases and comparative studies with other surgical methods.