Author/Editor     Andoljšek, Matej
Title     Odprta naravnava in notranja učrstitev sklepnih zlomov petnice: vpliv vrste zloma in skladnosti subtalarnega sklepa na funkcionalni rezultat zdravljenja
Translated title     Open reduction and internal fixation of displaced intraarticular fractures of the calcaneus: influence of type of fractures and congruency of the suntalar joint upon functional result
Type     članek
Source     Zdrav Vestn
Vol. and No.     Letnik 74, št. 11
Publication year     2005
Volume     str. 693-9
Language     slo
Abstract     Background. More and more, open reduction and internal fixation (ORIF) followed by early motion are advocated for displaced intraarticular fractures of the calcaneus. In prospective study the author asked, what are the results of ORIF with the calcaneal plate in intraarticular fractures of the calcaneus, and wheter type of fracture and/or congruity in the subtalar joint influence these results. Methods. Forty-three intraarticular fractures of the calcaneus (30 Type II, 10 Type III and 3 Type IV according to Sanders classification) were operated through extensile lateral approach. After reduction of the subtalar joint and restoration of the calcaneus shape, the fracture was fixed with the calcaneal plate. Mostly, surgery was delayed for a few days until soft tissues recuperate. Motion of the ankle and the subtalar joint was encouraged immediately, partial weight bearing after 6-8 weeks and full weight bearing after 3-4 month. After surgery, subtalar joint was found congruent in 33 (77%) and non-congruent (within 2 mm) in ten fractures. Results. Functional results of 36 fractures with a representative type distribution were evaluated 12 to 61 months postinjury. Functional results were satisfactory in 31 fractures (86%) and not satisfactory in five (14%). All fractures with unsatisfactory results were comminutive (Type III or IV). Four fractures with congruent joint had unsatisfactory, and eight of nine fractures with uncongruent joint had satisfactory result. Statistically, functional results of the comminuted fractures were significantly worse. However, functional results of fractures with non-congruent joint were comparable to the results of fractures with congruent joint and analysis of variance showed that interaction of these two factors was not important.
Summary     Izhodišča. Za dislocirane sklepne zlome petnice vse več avtorjev priporoča anatomsko naravnavo, stabilno učvrstitev s ploščico in zgodnje funkcionalno zdravljenje (ORIF-open reduction, internal fixation). V prospektivni študiji je avtorja zanimalo, kakšni so rezultati te metode zdravljenja in kako na rezultate zdravljenja vplivata vrsta zloma in dosežena skladnost subtalarnega sklepa. Metode. Triinštirideset sklepnih zlomov petnice (30 tipa II, 10 tipa III in 3 tipa IV po Sandersovi klasifikaciji) so operirali skozi razširjen lateralni pristop. Vse zlome so po uravnavi subtalarnega sklepa in rekonstrukciji petnice učvrstili s Sandersovo ploščico in vijaki. Zaradi poškodovanosti mehkih tkiv je bila večina operacij odloženih. Z aktivnim razgibavanjem skočnih sklepov so poškodovanci pričeli drugi dan po operaciji, z delno obremenitvijo po 6 do 8 tednih, s polno obremenitvijo pa po 3 do 4 mesecih. Na pooperativnih rentgenskih slikah (Brodenove projekcije) je bilo 33 subtalarnih sklepov skladnih (77%), deset pa ne. Rezultati. Funkcionalni rezultati 36 zlomov so bili ocenjeni po modificirani Seyfarthovi shemi 12 do 61 mesecev po operaciji. Enaintrideset zlomov ima odličen/dober funkcionalni rezultat (86%; uspešnost zdravljeni), pet zadovoljiv/slab (14%; neuspešno zdravljeni). Vsi neuspešno zdravljeni zlomi so bili kominutivni (tip III ali IV). Pri štirih zlomih s skladnim subtalarnim sklepom je bilo zdravljenje neuspešno, pri osmih od devetih z neskladnim subtalarnim sklepom pa uspešno. Statistično so bili rezultati kominutivnih zlomov pomembno slabši, medtem ko skladnost subtalarnega sklepa na rezultat ni pomembno vplivala. Analiza variance povezavo med kominucijo in skladnostjo sklepa izključuje.
Descriptors     CALCANEUS
FRACTURES
FRACTURE FIXATION, INTERNAL
BONE PLATES
BONE SCREWS
TREATMENT OUTCOME
PROSPECTIVE STUDIES