Çok parçalı kalkaneus kırıkların cerrahi tedavisinde kemik greftlemenin gerekliliği
Amaç: Bu çalışmada açık redüksiyon internal fiksasyon ile tedavi edilen eklem içi kalkaneus kırıklarında greftlemenin ameliyat sonrası radyolojik ve klinik sonuçlara katkısını ve olası komplikasyonlara etkisi araştırılmıştır. Gereç ve Yöntem: Greftleme yapılanlar [Grup 1 (n:21)] ve greftleme yapılmayanlar [Grup 2 (n:31)] hastalar klinik olarak Amerikan Ortopedik Ayak ve Bilek Skoru (AOFAS), radyolojik olarak Böhler açıları ve kalkaneal yükseklikleri komplikasyon olarak subtalar artroz, Sudeck atrofisi ve enfeksiyon oranları karşılaştırıldı.Bulgular: Her iki grup arasında kontrol AOFAS, ameliyat sonrası ve kontrol böhler açıları ve kalkaneal yükseklikleri açısından istatistiksel olarak fark gözlenmedi. Komplikasyon olarak subtalar artroz ve Sudeck atrofisi açısından istatistiksel bir fark gözlenmez iken enfeksiyon oranında anlamlı fark gözlendi. Kalkaneus kırıklarında redüksiyon sonrası posterior faset altında oluşan boşluğun greftlenmesinin klinik ve radyolojik iyileşmeye katkısı tartışmalıdır. Çalışmamızda klinik ve radyolojik iyileşmeye greflemenin ek katkısı olmadığını bulduk. Sonuç: Spongiyoz ve iyi kanlanan bir kemik olan kalkaneusun iyi bir redüksiyon ve tespit ardından oluşan boşluğu yeni kallus dokusu ile dolmaktadır ve ek olarak greftlemeye gerek yoktur.
The necessity of bone grafting in the surgical treatment of severely comminuted calcaneus fractures
Purpose: The aim of this study was to evaluate the effect of grafting on postoperative radiological and clinical outcomes and complications of intra-articular calcaneal fractures treated with open reduction internal fixation. Materials and Methods: Two groups as allograft used [Group 1 (n = 21)] and non-grafted [Group 2 (n = 31)] were compared for American Orthopedic Foot and Ankle Score (AOFAS), Bohler’s angles, calcaneal heights, subtalar arthrosis, Sudeck’s atrophy and infection rates.Results: There were no statistically significant differences between the two groups in terms of last AOFAS, postoperative and last Bohler’s angles and calcaneal heights. Although a statistically significant difference was not observed between the two groups for subtalar arthrosis and Sudeck’s atrophy, there was a significant difference in infection rate. Conclusion: In calcaneal fractures, the space which is created after anatomic reduction and fixation will be filled with new callus tissue thanks to the spongious nature of calcaneus, and there is no need for additional grafting.
___
- 1. Clare MP, Sanders RW. Fractures and dislocations of the calcaneus. In Rockwood and Green’s Fractures in Adults. 6th ed. (Eds RW Bucholz, JD Heckman, C Court-Brown, P Tornetta):2293-336. Philadelphia, Lippincott Williams & Wilkins, 2005.
- 2. Nork SE, Barei DP. Ankle and hindfoot trauma. In Orthopaedic Knowledge Update (Ed JS Fischgrund):493-509. Rosemont, American Academy of the Orthopaedic Surgeons, 2008.
- 3. Aşik M, Sen C, Bilen FE, Hamzaoğlu A. Surgical management of intraarticular calcaneus fractures. Acta Orthop Traumatol Turc. 2002;36:35-41.
- 4. Zwipp H, Rammelt S, Barthel S. Calcaneus fracture. Unfallchirurg. 2005;108:737-48.
- 5. Weber M, Lehmann O, Sagesser D, Krause F. Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. J Bone Joint Surg. 2008;90:1608–16.
- 6. Di Schino M, Bensaida M, Vandenbussche E, Augereau B, Nich C. Results of open reduction and cortico-cancellous autograft of intra-articular calcaneal fractures according to Palmer. Rev Chir Orthop Reparatrice Appar Mot. 2008;94:8-16.
- 7. Elsner A, Jubel A, Prokop A, Koebke J, Rehm KE, Andermahr J. Augmentation of intraarticular calcaneal fractures with injectable calcium phosphate cement: Densitometry, histology, and functional outcome of 18 patients. J Foot Ankle Surg. 2005;44:390–5.
- 8. Sanders R., Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intra-articular calcaneal fractures. Clin Orthop Relat Res. 1993;290:87–95.
- 9. Eastwood DM, Langkamer VG, Atkins RM. Intraarticular fractures of the calcaneum. Part II: Open reduction and internal fixation by the extended lateral transcalcaneal approach. J Bone Joint Surg Br. 1993;75:189–95.
- 10. Ebraheim NA, Elgafy H, Sabry FF, Freih M, AbouChakra IS.. Sinus tarsi approach with trans-articular fixation for displaced intra-articular fractures of the calcaneus. Foot Ankle Int. 2000;21:105–13.
- 11. Baumgaertel FR., Gotzen L. Two-stage operative treatment of comminuted os calcis fractures.Primary indirect reduction with medial external fixation and delayed lateral plate fixation. Clin Orthop Relat Res. 1993;290:132–41.
- 12. Huang PJ, Huang HT, Chen TB, Chen JC, Lin YK, Cheng YM et al. Open reduction and internal fixation of displaced intra-articular fractures of the calcaneus. J Trauma. 2002;52:946–50.
- 13. Letournel E. Open treatment of acute calcaneal fractures. Clin Orthop Relat Res. 1993;290:60–7.
- 14. Lowery RBW, Calhoun JH. Fractures of the calcaneus (current topic review). Foot Ankle Int. 1996;17;230– 5.
- 15. Longino D, Buckley RE. Bone graft in the operative treatment of displaced intraarticular calcaneal fractures: is it helpful? J Orthop Trauma. 2001;15:280–6.
- 16. Yunfeng Y, Homgmou Z, Zhou J, Yu G. Treatment displaced intraarticular calcaneal fractures with or wthout bone grafts: A systematic review of the literatüre. Indian J Orthop. 2012;46:130–7.
- 17. Cao H, Li YG. Short-term outcomes of open reduction and internal fixation for Sanders type iii calcaneal fractures with and without bone grafts. Foot Ankle Surg. 2017;1067:2516-7.
- 18. Singh A, Narsaria A, Verma I. Effect of bone grafting in short and long term outcomes of displaced intraarticular calcaneal fractures: A prospective comparative study. Int J Orthop 2016;183:505-11.