Modification of expanded lateral L-shaped approach for treatment of intraarticular fractures of calcaneus

Abstract

Objective To modify the expanded lateral L-shaped approach which is conventionally used to treat intraarticular fractures of calcaneus but likely leads to injury to the artery and sensory nerve at the calcaneal lateral skin area. Methods From July 2004 to January 2009, the modified expanded lateral L-shaped approach was used to treat 89 feet in 81 patients, 8 of whom had bilateral feet injured. The clinical effects were observed and compared with those of the other 32 patients who had been treated with the classic lateral L-shaped approach during the same period. Results The patients were followed up for 3 to 48 (average, 30.6) months. All fractures healed completely. By Maryland foot grading system, the modified group scored 84.37±12.22 averagely, with an excellent to good rate of 83.2%, while the classic group scored 81.72±13.91, with an excellent to good rate of 81.3%. There wee no significant differences between the 2 groups (t=1.014, P > 0.05; X~2=0.009, P>0.05). Only flap necrosis and lesion to sural cutaneous nerve occurred in the 2 groups and there were significant differences between the two (P < 0.05). Conclusion The modified expanded lateral L-shaped approach can protect maximally the lateral pedal artery and its con-comitant sural cutaneous nerve, thus effectively preventing such complications as flap necrosis, incision dis-union and skin functional impairment at the operation area. Key words: Calcaneal fracture; Fracture fixation,internal; Postoperative complications