Clinical effect of external fixator pinning in anterior process of calcaneus for treatment of AO/ASIF 43.Type A3 distal tibial fractures
ZHANG Haisen1 LIU Chang1 LIANG Dongqi2 WANG Huailiang3 PEI Baojing3 LIU Hui4 LIU Ying5
1.Department of Sports Medicine, Cangzhou Central Hospital, Hebei Province, Cangzhou 061001, China;
2.Department of Pain Management, Cangzhou Central Hospital, Hebei Province, Cangzhou 061001, China;
3.Department of the Second of Orthopedics, Cangzhou Central Hospital, Hebei Province, Cangzhou 061001, China;
4.Department of Orthopedics, Mumendian Hospital of Qing County, Hebei Province, Qing County 062650, China;
5.Operating Room, Cangzhou People′s Hospital, Hebei Province, Cangzhou 061001, China
Abstract：Objective To investigate clinical effect of the external fixator pinning in anterior process of calcaneus for treatment of AO/ASIF 43.Type A3 distal tibia fracture. Methods Thirty-six patients of AO/ASIF 43.Type A3 distal tibia fracture fixed by external fixator pinning in anterior process of calcaneus in the Department of Orthopedics, Cangzhou Central Hospital, Hebei Province from January 2013 to January 2018 were selected, and the relevant data were retrospectively analyzed. All cases were associated with fracture of shaft of distal fibula, and all fractures of distal tibia and fibula were closed fractures. During the operation, the distal end of the fracture was fixed with an external pin about 1 cm in the posterior medial side of the calcaneus and the anterior side of the sustentaculum of talus of calcaneus, and internal fixation of fracture of shaft of distal fibula was fixed with a posterolateral incision plate. Ankle flexion and extension training began 4 weeks after the operation, and relaxed the external fixator once a week. The operative time, intraoperative blood loss, fracture healing time and perioperative complications were recorded. The patients were followed up for 18 months after the operation. The clinical efficacy was evaluated by Maryland score, Lowa ankle joint score, and visual analogue scale (VAS) score. Results The average operative time was (42.6±23.8) min, the average intraoperative blood loss was (149.5±28.6) mL, and the average length of stay was (9.2±2.9) d. After the operation, one patient (2.8%) had superficial inflammatory reaction of fibula incision and one case (2.8%) had infection of external pin hole, and all healed after corresponding treatment. No vascular and nerve injury complications occurred in all cases. The overall incidence rate of perioperative complications was 5.6%. All cases were followed up for 18 months after the operation. Fracture healing was achieved in all cases without reduction loss. There were no statistically significant differences between the overall Lowa ankle score and VAS score at each postoperative time point (P ＞ 0.05). According to the Maryland score, the good rate of the curative effect was 88.9%. Conclusion The closed reduction and external fixator pinning in anterior process of calcaneus is an alternative treatment method in the early stage of AO/ASIF 43.Type A3 distal tibia fracture injury, which has good clinical efficacy, reliable fixation and low complication rate.
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2020, Vol. 17 
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