Abstract：
OBJECTIVE: To present a review of the clinical characteristics, preoperative and surgical management, and outcomes of patients with intra-articular calcaneal fractures who had open reduction and internal fixation (ORIF) and to offer some comments on and research ideas for the preoperative management of patients with these fractures.
METHODS: We studied consecutive patients who had ORIF performed by a single surgeon for closed, intra-articular calcaneal fractures at our level-1 trauma center between 5/29/2012 and 3/20/2018. All inpatients were treated with a preoperative soft tissue management protocol, whereas outpatients were not. Data were obtained about demographic and clinical characteristics, times from injury to surgery, quality of fracture reductions, and complication rates.
RESULTS: Mean follow-up for the 72 patients with 77 calcaneal fractures was 8.5 (range: 1-43) months, and 21 (27.3%) fractures received inpatient preoperative care with a soft tissue management protocol, while 56 (72.7%) received outpatient preoperative management. More of the fractures treated preoperatively as inpatients versus outpatients were classified as Sanders type III (66.7% vs. 32.1%) and type IV (8.9% vs. 4.8%) fractures and were associated with polytrauma (38.1% vs. 7.1%) and diabetes mellitus (9.5% vs. 5.4%), respectively. For all patients, the mean time from injury to surgery was 12.2 (range: 2.7-19.4) days, and the time was 6.3 days for inpatients and 14.4 days for outpatients, but the quality of fracture reductions and complication rates did not differ between these two groups.
CONCLUSIONS: Patients with intra-articular calcaneal fractures treated as inpatients and receiving a preoperative soft tissue management protocol had outcomes after ORIF that were not inferior to those experienced by patients treated preoperatively as outpatients, despite a greater proportion of the inpatients having severe fractures, polytrauma, and diabetes mellitus. Dedicated preoperative soft tissue management protocols may be beneficial for patients with calcaneal fractures and warrant further study.
METHODS: We studied consecutive patients who had ORIF performed by a single surgeon for closed, intra-articular calcaneal fractures at our level-1 trauma center between 5/29/2012 and 3/20/2018. All inpatients were treated with a preoperative soft tissue management protocol, whereas outpatients were not. Data were obtained about demographic and clinical characteristics, times from injury to surgery, quality of fracture reductions, and complication rates.
RESULTS: Mean follow-up for the 72 patients with 77 calcaneal fractures was 8.5 (range: 1-43) months, and 21 (27.3%) fractures received inpatient preoperative care with a soft tissue management protocol, while 56 (72.7%) received outpatient preoperative management. More of the fractures treated preoperatively as inpatients versus outpatients were classified as Sanders type III (66.7% vs. 32.1%) and type IV (8.9% vs. 4.8%) fractures and were associated with polytrauma (38.1% vs. 7.1%) and diabetes mellitus (9.5% vs. 5.4%), respectively. For all patients, the mean time from injury to surgery was 12.2 (range: 2.7-19.4) days, and the time was 6.3 days for inpatients and 14.4 days for outpatients, but the quality of fracture reductions and complication rates did not differ between these two groups.
CONCLUSIONS: Patients with intra-articular calcaneal fractures treated as inpatients and receiving a preoperative soft tissue management protocol had outcomes after ORIF that were not inferior to those experienced by patients treated preoperatively as outpatients, despite a greater proportion of the inpatients having severe fractures, polytrauma, and diabetes mellitus. Dedicated preoperative soft tissue management protocols may be beneficial for patients with calcaneal fractures and warrant further study.
摘要：
目的：对临床特征进行综述，术前和手术管理，对跟骨关节内骨折患者行切开复位内固定(ORIF)的治疗结果进行分析,并对这些骨折患者的术前处理提出一些意见和研究思路。
方法：我们研究了由一名外科医生进行闭合ORIF的连续患者，2012年5月29日至2018年3月20日在我们的1级创伤中心发生跟骨关节内骨折。所有住院患者均采用术前软组织管理方案，而门诊患者则没有。获得了有关人口统计学和临床特征的数据，从受伤到手术，骨折复位质量，和并发症发生率。
结果：72例跟骨骨折77例患者的平均随访时间为8.5（范围：1-43）个月，21例（27.3%）骨折患者接受了软组织管理方案的住院术前护理，56例(72.7%)接受了门诊术前管理。术前住院患者与门诊患者相比，更多的骨折被归类为SandersIII型（66.7％vs.32.1%）和IV型（8.9%与4.8%）骨折，并伴有多发性创伤（38.1%vs.7.1％）和糖尿病（9.5％vs.5.4%），分别。对于所有患者来说，从受伤到手术的平均时间为12.2（范围：2.7-19.4）天，住院病人的时间为6.3天，门诊病人为14.4天，但两组的骨折复位质量和并发症发生率无差异.
结论：跟骨关节内骨折患者作为住院患者接受术前软组织管理方案治疗，其ORIF治疗后的结果并不低于术前门诊患者的结果。尽管住院患者中严重骨折的比例更高，多发性创伤,和糖尿病。专门的术前软组织处理方案可能对跟骨骨折患者有益，值得进一步研究。
方法：我们研究了由一名外科医生进行闭合ORIF的连续患者，2012年5月29日至2018年3月20日在我们的1级创伤中心发生跟骨关节内骨折。所有住院患者均采用术前软组织管理方案，而门诊患者则没有。获得了有关人口统计学和临床特征的数据，从受伤到手术，骨折复位质量，和并发症发生率。
结果：72例跟骨骨折77例患者的平均随访时间为8.5（范围：1-43）个月，21例（27.3%）骨折患者接受了软组织管理方案的住院术前护理，56例(72.7%)接受了门诊术前管理。术前住院患者与门诊患者相比，更多的骨折被归类为SandersIII型（66.7％vs.32.1%）和IV型（8.9%与4.8%）骨折，并伴有多发性创伤（38.1%vs.7.1％）和糖尿病（9.5％vs.5.4%），分别。对于所有患者来说，从受伤到手术的平均时间为12.2（范围：2.7-19.4）天，住院病人的时间为6.3天，门诊病人为14.4天，但两组的骨折复位质量和并发症发生率无差异.
结论：跟骨关节内骨折患者作为住院患者接受术前软组织管理方案治疗，其ORIF治疗后的结果并不低于术前门诊患者的结果。尽管住院患者中严重骨折的比例更高，多发性创伤,和糖尿病。专门的术前软组织处理方案可能对跟骨骨折患者有益，值得进一步研究。
