Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment
Yıl: 2019 Cilt: 30 Sayı: 2 Sayfa Aralığı: 143 - 148 Metin Dili: İngilizce DOI: 10.5606/ehc.2019.66447 İndeks Tarihi: 25-11-2019
Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment
Öz: Objectives: This study aims to compare the radiological, clinical and patient-reported outcomes of patients with intra-articular calcaneus fractures treated conservatively or surgically. Patients and methods: Fifty-four patients (30 males, 24 females; mean age 41.0 years; range, 18 to 73 years) treated due to calcaneus fracture were included in the study. Twenty-nine patients underwent conservative treatment (group 1) and 25 patients underwent surgical treatment (group 2). The fractures were classified according to Sanders. At the final follow-up, patients’ Bohler’s angle, The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score and Foot Function Index (FFI) were used to evaluate their radiological, clinical and patient-reported outcomes. Postoperative complications were also noted. Results: The fracture was at the right foot in 28 patients and the left foot in 26 patients. The mean follow-up duration was 41.1±23.2 months (range, 24 to 126 months). No statistically significant differences were found between the groups in terms of gender, fracture side, mean age, or follow-up duration (p=0.951, p=0.571, p=0.326, and p=0.620, respectively). According to Sanders classification, 18 patients were type 2 and 11 patients were type 3 in group 1, while 11 patients were type 2 and 14 patients were type 3 in group 2. However, there was no statistically significant difference between the groups in terms of the type of the fracture (p=0.184). On the other hand, the outcomes were significantly better for group 2 compared to group 1 in terms of the Bohler’s angle, AOFAS and FFI scores (p=0.004, p=0.003 and p=0.006, respectively). In group 1, subtalar arthritis developed in three patients. In group 2, wound healing problems and superficial infection developed in three patients, while subtalar arthritis developed in two patients. Conclusion: Surgical treatment is more effective in intra-articular calcaneus fractures compared to conservative treatment according to clinical, radiological and patient-reported outcomes. In addition, wound problems should be considered in surgical management.
Anahtar Kelime: Konular:
Eklem içi kalkaneus kırıklarında klinik, radyolojik ve hasta raporlu sonuçlar: Konservatif ve cerrahi tedavinin karşılaştırılması
Öz: Amaç: Bu çalışmada konservatif veya cerrahi olarak tedavi edilen eklem içi kalkaneus kırıklı hastaların radyolojik, klinik ve hasta raporlu sonuçları karşılaştırıldı. Hastalar ve yöntemler: Çalışmaya kalkaneus kırığı nedeni ile tedavi edilen 54 hasta (30 erkek, 24 kadın; ort. yaş 41.0 yıl; dağılım, 18-73 yıl) dahil edildi. Yirmi dokuz hastaya konservatif tedavi (grup 1) ve 25 hastaya cerrahi tedavi (grup 2) uygulandı. Kırıklar Sanders’e göre sınıflandırıldı. Son takipte hastaların radyolojik, klinik ve hasta raporlu sonuçlarını değerlendirmek için Bohler açısı, Amerikan Ortopedik Ayak-Ayak Bileği Derneği (AOFAS) Ayak Bileği ve Arka Ayak Skoru ve Ayak Fonksiyon İndeksi (AFİ) kullanıldı. Ameliyat sonrası komplikasyonlar da kaydedildi. Bulgular: Yirmi sekiz hastada kırık sağ ayakta ve 26 hastada sol ayakta idi. Ortalama takip süresi 41.1±23.2 ay (dağılım, 24-126 ay) idi. Gruplar arasında cinsiyet, kırık tarafı, ortalama yaş ve takip süresi bakımından istatistiksel olarak anlamlı farklılık bulunmadı (sırasıyla, p=0.951, p=0.571, p=0.326 ve p=0.620). Sanders sınıflandırmasına göre, grup 1’de 18 hasta tip 2 ve 11 hasta tip 3 iken grup 2’de 11 hasta tip 2 ve 14 hasta tip 3 idi. Ancak gruplar arasında kırık tipi açısından istatistiksel olarak anlamlı farklılık yoktu (p=0.184). Diğer yandan; Bohler açısı, AOFAS ve AFİ skorları bakımından sonuçlar grup 2 için grup 1’e kıyasla anlamlı olarak daha iyi idi (sırasıyla, p=0.004, p=0.003 ve p=0.006). Grup 1’de üç hastada subtalar artrit gelişti. Grup 2’de üç hastada yara iyileşme sorunları ve yüzeyel enfeksiyon gelişirken iki hastada subtalar artrit gelişti. Sonuç: Klinik, radyolojik ve hasta raporlu sonuçlara göre eklem içi kalkaneus kırıklarında cerrahi tedavi konservatif tedaviye kıyasla daha etkilidir. Bununla birlikte, cerrahi tedavide yara sorunlarına dikkat edilmelidir.
Anahtar Kelime: Konular:
Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
- Gilani SF, Amin MS. Operative treatment of displaced intra-articular fractures of Calcaneum: Is it worthwhile? J Pak Med Assoc 2014;64:161-6.
- Gougoulias N, Khanna A, McBride DJ, Maffulli N. Management of calcaneal fractures: systematic review of randomized trials. Br Med Bull 2009;92:153-67.
- Howard JL, Buckley R, McCormack R, Pate G, Leighton R, Petrie D, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma 2003;17:241-9.
- Bruce J, Sutherland A. Surgical versus conservative interventions for displaced intra-articular calcaneal fractures. Cochrane Database Syst Rev 2013;1:CD008628.
- Dhillon MS, Prabhakar S. Treatment of displaced intraarticular calcaneus fractures: a current concepts review. SICOT J 2017;3:59.
- Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res 1993;290:87-95.
- Konya MN, Sargın S. Does Treatment Modality Affect Clinical Results of Calcaneal Fractures: A Retrospective Comparative Study. Acta Medica Alanya 2017;1:23-8.
- Kınık H, Yıldız Y, Mergen E. Early and mid-term results of surgically treated intra-articular calcaneal fractures. Eklem Hastalik Cerrahisi 2001;12:2:161-8.
- Omoto H, Sakurada K, Sugi M, Nakamura K. A new method of manual reduction for intra-articular fracture of the calcaneus. Clin Orthop Relat Res 1983;177:104-11.
- De Boer AS, Van Lieshout EM, Den Hartog D, Weerts B, Verhofstad MH, Schepers T. Functional outcome and patient satisfaction after displaced intra-articular calcaneal fractures: a comparison among open, percutaneous, and nonoperative treatment. J Foot Ankle Surg 2015;54:298-305
- Budiman-Mak E, Conrad KJ, Roach KE. The Foot Function Index: a measure of foot pain and disability. J Clin Epidemiol 1991;44:561-70.
- Ibrahim T, Beiri A, Azzabi M, Best AJ, Taylor GJ, Menon DK. Reliability and validity of the subjective component of the American Orthopaedic Foot and Ankle Society clinical rating scales. J Foot Ankle Surg 2007;46:65-74.
- Veltman ES, Doornberg JN, Stufkens SA, Luitse JS, van den Bekerom MP. Long-term outcomes of 1,730 calcaneal fractures: systematic review of the literature. J Foot Ankle Surg 2013;52:486-90.
- Thordarson DB, Krieger LE. Operative vs. nonoperative treatment of intra-articular fractures of the calcaneus: a prospective randomized trial. Foot Ankle Int 1996;17:2-9.
- Melcher G, Degonda F, Leutenegger A, Rüedi T. Tenyear follow-up after operative treatment for intra-articular fractures of the calcaneus. J Trauma 1995;38:713-6.
- Gülabi D, Sarı F, Sen C, Avcı CC, Sağlam F, Erdem M, et al. Mid-term results of calcaneal plating for displaced intraarticular calcaneus fractures. Ulus Travma Acil Cerrahi Derg 2013;19:145-51.
- Kundel K, Funk E, Brutscher M, Bickel R. Calcaneal fractures: operative versus nonoperative treatment. J Trauma 1996;41:839-45.
- Kennedy JG, Jan WM, McGuinness AJ, Barry K, Curtin J, Cashman WF, et al. An outcomes assessment of intraarticular calcaneal fractures, using patient and physician's assessment profiles. Injury 2003;34:932-6.
- Atik OŞ. Which articles do we prefer to publish? Eklem Hastalik Cerrahisi 2018;29:1.
- Makki D, Alnajjar HM, Walkay S, Ramkumar U, Watson AJ, Allen PW. Osteosynthesis of displaced intra-articular fractures of the calcaneum: a long-term review of 47 cases. J Bone Joint Surg [Br] 2010;92:693-700.
- Bakker B, Halm JA, Van Lieshout EM, Schepers T. The fate of Böhler’s angle in conservatively-treated displaced intraarticular calcaneal fractures. Int Orthop 2012;36:2495-9.
- Kulkarni HG, Mane VS, Gaonkar KL, Patil PP, Shaha MS, Patel NS, et al. Plating for intra-articular calcaneal fractures…. Is it an overkill? J Clin Orthop Trauma 2015;6:153-9.
- Rak V, Ira D, Masek M. Operative treatment of intraarticular calcaneal fractures with calcaneal plates and its complications. Indian J Orthop 2009;43:271-80.
| APA | Aslan A, SARGIN S, Gülcü A, KONYA M (2019). Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment. , 143 - 148. 10.5606/ehc.2019.66447 |
| Chicago | Aslan Ahmet,SARGIN SERDAR,Gülcü Anıl,KONYA Mehmet Nuri Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment. (2019): 143 - 148. 10.5606/ehc.2019.66447 |
| MLA | Aslan Ahmet,SARGIN SERDAR,Gülcü Anıl,KONYA Mehmet Nuri Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment. , 2019, ss.143 - 148. 10.5606/ehc.2019.66447 |
| AMA | Aslan A,SARGIN S,Gülcü A,KONYA M Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment. . 2019; 143 - 148. 10.5606/ehc.2019.66447 |
| Vancouver | Aslan A,SARGIN S,Gülcü A,KONYA M Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment. . 2019; 143 - 148. 10.5606/ehc.2019.66447 |
| IEEE | Aslan A,SARGIN S,Gülcü A,KONYA M "Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment." , ss.143 - 148, 2019. 10.5606/ehc.2019.66447 |
| ISNAD | Aslan, Ahmet vd. "Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment". (2019), 143-148. https://doi.org/10.5606/ehc.2019.66447 |
| APA | Aslan A, SARGIN S, Gülcü A, KONYA M (2019). Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 30(2), 143 - 148. 10.5606/ehc.2019.66447 |
| Chicago | Aslan Ahmet,SARGIN SERDAR,Gülcü Anıl,KONYA Mehmet Nuri Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 30, no.2 (2019): 143 - 148. 10.5606/ehc.2019.66447 |
| MLA | Aslan Ahmet,SARGIN SERDAR,Gülcü Anıl,KONYA Mehmet Nuri Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), vol.30, no.2, 2019, ss.143 - 148. 10.5606/ehc.2019.66447 |
| AMA | Aslan A,SARGIN S,Gülcü A,KONYA M Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2019; 30(2): 143 - 148. 10.5606/ehc.2019.66447 |
| Vancouver | Aslan A,SARGIN S,Gülcü A,KONYA M Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment. Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.). 2019; 30(2): 143 - 148. 10.5606/ehc.2019.66447 |
| IEEE | Aslan A,SARGIN S,Gülcü A,KONYA M "Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment." Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.), 30, ss.143 - 148, 2019. 10.5606/ehc.2019.66447 |
| ISNAD | Aslan, Ahmet vd. "Clinical, radiological and patient-reported outcomes in intra-articular calcaneal fractures: Comparison of conservative and surgical treatment". Eklem Hastalıkları ve Cerrahisi Dergisi (Eski Adı: Artroplasti Artroskopik Cerrahi Derg.) 30/2 (2019), 143-148. https://doi.org/10.5606/ehc.2019.66447 |
