Objective: To compare the clinical outcome between the two different approaches of improved lateral incision and the traditional L-shaped extension incision to treat intra-articular calcaneal fractures.
Methods: From January 2005 to January 2008, 36 cases of intra-articular calcaneal fractures were treated by improved lateral incision or the traditional L-shaped extension incision. In improved lateral incision group, there were 19 cases including 12 males and 7 females with an average age of (38.1 +/- 9.1) years; According to Sanders classification: 8 cases were type II, 9 were type III, 2 were type IV; The time from injury to the operation was (10.5 +/- 1.7) days. In the traditional L-shaped extension incision group,there were 17 cases including 11 males and 6 females with an average age of (38.4 +/- 7.3) years; according to Sanders classification of fractures: 7 cases were type II, 9 were type III, 1 was type IV; The time from injury to the operation was (10.6 +/- 1.8) days. Observing and comparing some items of the two groups including (1) operation time, blood loss, incision length, number of graft cases, (2) VAS pain scores after the first day, (3) wound healing, (4) Maryland foot scoring, (5) postoperative imaging results were comparative analyzed.
Results: Two groups of patients were followed up from 10 to 15 months with an average of 11 months. The operative time and number of graft cases were compared between two groups with no statistically significant differences. The blood loss were (94.0 +/- 9.5) ml in improved lateral incision group and (109.9 +/- 13.7) ml in L-shaped extension incision group, incision length were (6.8 +/- 1.1) cm in improved lateral incision group and (15.7 +/- 2.2) cm in L-shaped extension incision group with significant differences. Postoperative VAS pain score at the first day were (1.95 +/- 0.71) points in improved lateral incision group and (3.65 +/- 1.00) points in L-shaped incision group with significant difference. In improved lateral incision group there was 1 case of grade B wound healing, and in the traditional L-shaped extension incision group, there were 6 cases of grade B wound healing, these patients were healing by protensive time for change dress.
Conclusion: These two incision of improved lateral incision and the traditional L-shaped extension incision for treating the intra-articular calcaneal fractures are therapeutic equivalence. However, improved lateral incision has advantage of small incision and operative wound, and fewer wound complications.