Abstract
IIntroduction The scope of examination of patients with closed intraarticular fractures of the calcaneus against the background of concomitant pathology has been discussed up to date. The aim of the study was to improve the accuracy of predicting the nature of postoperative wound healing after osteosynthesis of intra-articular fractures of the calcaneus from the extended lateral approach on the background of chronic obliterating diseases of the lower limb arteries of different etiology, smoking and a combination of these factors. Material and methods Sixty-nine patients who were smokers and/or suffered from chronic obliterating diseases with a total of 74 closed intra-articular fractures of the heel bones were analyzed. All patients received a comprehensive clinical and instrumental examination consisting of radiography and computed tomography of the calcaneus to determine the proximal-distal gradient (PDG), ankle-brachial index (ABI) and transcutaneous oximetry (TrOc). A single-factor analysis of variance was performed, after which an expert evaluation of the features was performed, as well as testing of models with different sets of signs. Results The disperse analysis of variance in respect of 74 cases for the relevant group of patients allowed us to obtain two models: the first with a level of statistical significance p0 less 0,001 (χ2 – 82,63; df = 7) and the predictive efficiency of 97.3 % in regard to possible complications after open reduction with internal fixation; the second level of statistical significance p0 less 0,001 (χ2 – 34,76; df = 7) and prognostic effectiveness of 93,24 % related to the risk of repeated surgical interventions. Conclusions The proposed method of predicting the development of complications in the immediate postoperative period after internal osteosynthesis of the calcaneus allows estimation of the risks of complications by calculating PDG, ABI and TrOc with high efficiency (97.3 %). The proposed discriminant model predicts the need for repeated surgical interventions with an efficiency of 93.24 %, and feasibility of surgical treatment with an extended lateral approach.
Highlights
The scope of examination of patients with closed intraarticular fractures of the calcaneus against the background of concomitant pathology has been discussed up to date
The examination protocol was supplemented by several specialized instrumental techniques, including remote infrared polypositional thermometry (DIPT) with the determination of the proximal distal gradient (PDG); segmental manometry with determination of the ankle brachial index (ABI) and transcutaneous oximetry (TrOx)
As a natural result of studying the features of the nature of surgical wound healing after open reduction and internal fixation (ORIF) of the calcaneus from extended lateral approach in patients affected by chronic lower limb arterial insufficiency (CLLAI), we considered a mathematical multidimensional model for predicting short-term complications
Summary
The scope of examination of patients with closed intraarticular fractures of the calcaneus against the background of concomitant pathology has been discussed up to date. The aim of the study was to improve the accuracy of predicting the nature of postoperative wound healing after osteosynthesis of intra-articular fractures of the calcaneus from the extended lateral approach on the background of chronic obliterating diseases of the lower limb arteries of different etiology, smoking and a combination of these factors. Chronic obliterating diseases of the lower limbs arteries (CDLLA) that cause microcirculatory disorders are encountered in 3 % of the working age population in the Russian Federation. Their preclinical condition may be four times greater in number [7–9].
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