Abstract：
BACKGROUND: Calcaneal fractures are often major injuries associated with considerable morbidity. The optimal surgical management of displaced calcaneal fractures remains contentious with open, percutaneous and arthroscopically assisted percutaneous approaches all offering potential benefits for patients. The aim of this study was to assess which of these three separate surgical approaches to the management of displaced calcaneal fractures provides the best radiographic deformity correction.
METHODS: This is a retrospective observational study of all calcaneal fractures undergoing operative fixation at a single major trauma centre in the UK. The primary outcome was pre- and post-operative assessment of the deformity correction using radiographic parameters (angle of Gissane and Bohler\'s angle). Secondary outcomes included fracture configuration, complications and re-operation rate.
RESULTS: Between 01/01/2009 and 31/12/2019, 152 calcaneal fractures in 134 patients underwent operative management via either an open or percutaneous approach. One-way ANOVA testing of the pre- and post-operative radiographic parameters demonstrated that an open approach offered superior post-operative correction of Bohler\'s angle when compared to percutaneous alone (p < 0.05); however, there was no difference in post-operative angle of Gissane (p > 0.05). The mean follow-up for complication and re-operation data was 3.5 years (range 0.1-12.4). Overall complication rate following all surgical fixation was 7.2% with a further 32.2% requiring further long-term surgical intervention for subtalar arthritis or removal of metalwork.
CONCLUSIONS: Arthroscopically assisted percutaneous fixation does not offer superior radiographic deformity correction compared to percutaneous technique alone. Open fixation yielded improved correction of Bohler\'s angle when compared to percutaneous alone; however, there was no difference in post-operative angle of Gissane.
METHODS: III.
METHODS: This is a retrospective observational study of all calcaneal fractures undergoing operative fixation at a single major trauma centre in the UK. The primary outcome was pre- and post-operative assessment of the deformity correction using radiographic parameters (angle of Gissane and Bohler\'s angle). Secondary outcomes included fracture configuration, complications and re-operation rate.
RESULTS: Between 01/01/2009 and 31/12/2019, 152 calcaneal fractures in 134 patients underwent operative management via either an open or percutaneous approach. One-way ANOVA testing of the pre- and post-operative radiographic parameters demonstrated that an open approach offered superior post-operative correction of Bohler\'s angle when compared to percutaneous alone (p < 0.05); however, there was no difference in post-operative angle of Gissane (p > 0.05). The mean follow-up for complication and re-operation data was 3.5 years (range 0.1-12.4). Overall complication rate following all surgical fixation was 7.2% with a further 32.2% requiring further long-term surgical intervention for subtalar arthritis or removal of metalwork.
CONCLUSIONS: Arthroscopically assisted percutaneous fixation does not offer superior radiographic deformity correction compared to percutaneous technique alone. Open fixation yielded improved correction of Bohler\'s angle when compared to percutaneous alone; however, there was no difference in post-operative angle of Gissane.
METHODS: III.
摘要：
背景：跟骨骨折通常是与相当大的发病率相关的主要损伤。移位的跟骨骨折的最佳手术治疗仍与开放性，经皮和关节镜辅助的经皮方法都为患者提供了潜在的益处。这项研究的目的是评估这三种独立的手术方法中哪一种可以治疗移位的跟骨骨折，可以提供最佳的放射学畸形矫正。
方法：这是一项回顾性观察性研究，对英国单一主要创伤中心的所有跟骨骨折进行手术固定。主要结果是使用影像学参数（Gissane角度和Bohler角度）对畸形矫正进行术前和术后评估。次要结果包括骨折构型，并发症和再次手术率。
结果：在2009年1月1日至2019年12月31日之间，134例患者的152例跟骨骨折接受了开放或经皮手术治疗。术前和术后影像学参数的单因素方差分析测试表明，与单独经皮相比，开放入路对Bohler角度的术后矫正效果更好(p<0.05)；然而，Gissane术后角度无差异(p>0.05)。并发症和再次手术数据的平均随访时间为3.5年（范围0.1-12.4）。所有手术固定后的总并发症发生率为7.2％，另外32.2％需要对距下关节炎进行进一步的长期手术干预或去除金属制品。
结论：与单纯经皮技术相比，关节镜辅助经皮内固定术不能提供更好的影像学畸形矫正。与单独经皮固定相比，开放固定改善了Bohler角度的矫正；然而，Gissane术后角度无差异。
方法：III.
方法：这是一项回顾性观察性研究，对英国单一主要创伤中心的所有跟骨骨折进行手术固定。主要结果是使用影像学参数（Gissane角度和Bohler角度）对畸形矫正进行术前和术后评估。次要结果包括骨折构型，并发症和再次手术率。
结果：在2009年1月1日至2019年12月31日之间，134例患者的152例跟骨骨折接受了开放或经皮手术治疗。术前和术后影像学参数的单因素方差分析测试表明，与单独经皮相比，开放入路对Bohler角度的术后矫正效果更好(p<0.05)；然而，Gissane术后角度无差异(p>0.05)。并发症和再次手术数据的平均随访时间为3.5年（范围0.1-12.4）。所有手术固定后的总并发症发生率为7.2％，另外32.2％需要对距下关节炎进行进一步的长期手术干预或去除金属制品。
结论：与单纯经皮技术相比，关节镜辅助经皮内固定术不能提供更好的影像学畸形矫正。与单独经皮固定相比，开放固定改善了Bohler角度的矫正；然而，Gissane术后角度无差异。
方法：III.
