Views: 3 Author: Site Editor Publish Time: 2022-08-27 Origin: Site
The clinicopathological changes of calcaneal fractures include arch collapse, lateral calcaneal wall bulge, talus dorsiflexion, limb shortening, articular surface irregularity, collapse, turnover, articular surface destruction and cartilage damage, heel varus and valgus deformity, Heel-fibular impingement, fibular long and short tendon entrapment, hindfoot alignment changes, plantar force distribution changes, hindfoot movement and gait abnormalities, hindfoot shape changes, and difficulty in wearing shoes.
The main manifestations of fresh calcaneal fracture are local pain, tenderness, bone friction, local swelling, subcutaneous ecchymosis, heel deformity, and limited mobility. Old calcaneal fractures can manifest as chronic swelling, pain, deformity, and dysfunction of the heel, such as motor dysfunction, weight-bearing dysfunction, and difficulty in wearing shoes.
The treatment of calcaneal fractures can be divided into non-surgical treatment and surgical treatment.
Longitudinal tubercle fractures: compression bandaging can be used for those without displacement, and lateral compression reduction with calcaneal traction can be used for patients with displacement, and then external fixation with a plaster.
Fractures at the level of the tubercle: patients without displacement can be fixed with a plaster cast, and those with displacement can be reduced by open reduction and fixed with screws if the manipulation cannot be reduced.
No displacement load talus fracture.
For calcaneal protrusion fracture, the calf cast can be fixed with external fixation, and the nonunion can be resected.
For fractures close to the calcaneal joint, if there is no displacement, use a plaster cast for external fixation; if there is significant displacement, the calcaneal tubercle should be reduced by traction to restore the joint angle of the tuberosity, and the widening deformity of the calcaneus should be restored and then fixed with a plaster cast. . In addition, non-surgical treatment is also considered in the following cases: ① patients with severe cardiovascular and diabetes, or life-threatening fractures with severe compound injuries; ② joint reconstruction is unnecessary or meaningless, elderly people who cannot walk or have paraplegia; ③ Intra-articular fracture with fracture displacement <2mm.
In the treatment of calcaneal fractures, the normal biomechanical characteristics of the back of the foot should be restored as far as possible;
Fractures should be accurately reduced, and anatomical reduction should be achieved for fractures involving the lower joint and the calcaneocuboid joint, the leveling of the subtalar articular surface and the normal anatomical relationship between the three articular surfaces should be restored, and the overall shape and length and width of the calcaneus should be restored. , Advanced geometric parameters, restore Gissane angle, Böhler angle, correct varus and valgus deformity, and restore the load-bearing axis of the hind foot;
The fixation method should be reliable and stable, allow early functional exercise and early weight bearing, reduce postoperative pain and joint stiffness, and reduce the incidence of soft tissue injury and incision complications.
Common early complications of calcaneal fractures include soft tissue injury, swelling, tension blisters, septal syndrome, and deep vein thrombosis.
Elevate the affected limb so that it is higher than the level of the heart, and it can be brought to the level of the heart when the fascial compartment syndrome is suspected;
application of anti-swelling drugs, such as 20% mannitol intravenous drip.
ice pack cold compress;
Apply foot arterial venous pump;
For those with obvious blisters, the blisters can be suctioned, and the elastic bandage after disinfection is effective.
The principles of treatment of fascial compartment syndrome are early detection, early diagnosis, and timely and correct treatment, to prevent the occurrence and development of the disease to the greatest extent, prevent foot muscle necrosis and nerve dysfunction, and restore the function of the affected foot to the greatest extent. Attention should be paid to prevention, and attention should be paid to the potential signs of ischemia in the early stage. If it is found that there is a tendency to develop the disease, any bandages, plaster casts, and braces should be avoided. The foot is placed at heart level to take advantage of venous return and prevent foot ischemia. Intravenous infusion of mannitol. Once diagnosed, it should be treated urgently, and the most effective method is fasciotomy for decompression.
Basic measures include: a. Early functional exercise in bed; b. Drink plenty of water, add fluids appropriately, and correct hypovolemia; c. Apply lipid-lowering drugs to patients with hyperlipidemia and diabetes and try to control blood sugar within the normal range; d. Heart failure Patients should actively improve cardiac function; e. avoid high cholesterol and greasy diets; f. prohibit smoking, etc.
Mechanical measures include: a. Wearing step-by-step compression stockings for lower extremities; b. Application of plantar venous pump; c. Intermittent inflatable compression device.
Drug prevention includes heparin, low molecular weight heparin, aspirin, vitamin K antagonists and pentosan sodium.
The affected limb should be elevated for 3 days after the operation, and passive activities of the toes should be started 24 hours after the operation; active and passive activities of the toes and ankle joints should be started at 48 hours, and the activities should be mainly flexion and extension and gradually strengthened. Start again 4 to 6 weeks after surgery; full weight-bearing of the affected foot is required after the fracture has healed.
For displaced intra-articular fractures of the calcaneus, open reduction and plate fixation are still the most commonly used treatment methods. At present, there are many types of plates used for calcaneal fractures, such as AO plate, "H"-shaped plate, "Y"-shaped plate, reconstruction plate, anatomical plate, small butterfly plate, etc. How to choose an appropriate calcaneal plate should consider the following factors: the effectiveness of fixation; the reliability of fixation; minimally invasive; conforming to fracture characteristics and fragment size; conforming to biomechanical characteristics such as hindfoot weight bearing and better histocompatibility sex.
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