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 February2012,52 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 18to 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 Ⅳfractures. All patients were examed with X ray and CT. Bhler 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(57feet) were followed up for 5 to 16 months,with an average of 7.2 months. Calcaneal Bhler angle increased from(12.65 ±5.32)°preoperatively to(30.63±4.28) ° postoperatively. The calcaneal Gissane angle decreased from(129.87±6.25) ° preoperatively to(122.11±4.89) ° 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,Bhler angle and Gissane angle were improved significantly(P0.05). 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.