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KMID : 0896720030070020238
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Journal of the Korean Society of Foot Surgery
2003 Volume.7 No. 2 p.238 ~ p.249
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Result of Surgical Treatment of Intra-Articular Fractures of the Calcaneus - Based on CT Classification and Open Reduction and Interanl Fixation -
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Kim Eui-Soon
Moon Myung-Sang
Seo Hyun-Mo
Choi Hun-Hwi
Lee Man-Hee
Choi Won-Tae
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Abstract
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Purpose:To report the clinical result of the intraarticular calcaneus fracture after open reduction and internal fixation with plate by lateral approach.
Material and Methods : Thirty-six calcaneal fractures of 33 patients(29 men and 4 women) were treated by open reduction and internal fixation using and lateral approach from March, 197 to May, 2002 and were followed more than one year. The autogenous iliac bone graft was done in 2 cases but the others didn’t. Radiographicaaly Bohler angle and Gissane angle on simple lateral radiograph were measured and in the 15 cases, the step-off(gap) of posterior facet joint on post-operative CT images were followed. The Salama method was used for evaluation of clinical results.
Results: According to Sanders classification, 19 cases of the 36 cases were classified as type Ⅱ. Type Ⅲ fracture were found in 12 cases and type Ⅳ in 5 cases. The following results were obtained: twenty-two cases(61.1%) out of 36 cases were estimated as good or excellent. The good results or more were obtained in 15 cases(78.9%) in type Ⅱ and 7 cases(58.3%) in type Ⅲ, but no case in type Ⅳ. Bohler angles were improved from preoperative average 1.6? to postoperative average 23.4?, Gissane angle was improved from preoperative 107.2?to postoperative 122.87?, respectively. Among 36 cases, computed tomography was carried out in 15 cases. The postoperative step-off (gap) of posterior facet joint on computed tomography was filled with cancellous bone. Satisfactory results was obtained in 7 cases with 2mm gap or less and in 6 cases of 2-5mm. There were no satisfactory results in 2 cases with 5mm gap or more.
Conclusions:Open reduction and internal fixation for intra-articular fracture of calcaneus was thought to be a good treatment modality. It is thought that the lateral approach is one of the good one for surgical treatment, and that accurate reduction of the posterior facet, acceptable recovery of Bohler angle are more important to obtain best results.
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KEYWORD
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Calcaneus fracture, Intra-articular fracture, Lateral approach
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