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Outcome nach operativer Therapie von Kalkaneusfrakturen

Outcome after surgical treatment of calcaneal fractures

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Zusammenfassung

Hintergrund

Die Therapie der Kalkaneusfraktur wird in der Literatur kontrovers diskutiert. Zur Untersuchung des eigenen Kollektivs wurde eine retrospektive Nachuntersuchung in einem Traumazentrum der Maximalversorgung durchgeführt.

Ziel der Arbeit

Untersuchung von Einflussfaktoren auf die Versorgungsqualität von operativ behandelten Kalkaneusfrakturen.

Material und Methoden

Von 2005 bis 2013 wurden 90 Patienten mit Kalkaneusfrakturen in unserer Klinik mittels winkelstabiler Plattenosteosynthese behandelt, wovon 48 Patienten mit 55 Frakturen retrospektiv untersucht wurden. Radiologisch erfolgten die Beurteilung hinsichtlich einer posttraumatischen Arthrose sowie die Bestimmung der Böhler- und Gissane-Winkel. Klinisch wurden AOFAS(American Orthopaedic Foot and Ankle Society)- und SF-36 (Short Form Health 36) Scores erhoben. Die Ergebnisse wurden hinsichtlich möglicher Risikofaktoren statistisch überprüft.

Ergebnisse

Insgesamt traten bei 9 Patienten (18,8 %) revisionspflichtige Komplikationen auf, davon 8 Patienten mit subtalarer Arthrodese und ein Patient mit Wundinfektion.

Nikotinabusus und ein verlängerter Zeitraum zwischen Trauma und Operation waren Faktoren, die Einfluss auf die Entwicklung von Wundheilungsstörungen hatten.

Der AOFAS Score lag durchschnittlich bei 68, der SF-36 bei 58,86 Punkten.

Ein schlechteres Ergebnis in den Scores war durch die Entwicklung einer Arthrose und den Versicherungsstatus bedingt. Faktoren wie erhöhtes Alter oder eine komplexe Frakturform korrelierten in unserem Kollektiv nicht mit einem schlechteren Ergebnis.

Diskussion

In unserem Kollektiv waren Nikotinabusus und ein langer Zeitraum bis zur Operation Risikofaktoren für Wundinfektionen. Die Ergebnisqualität wurde weiter durch die postoperative Entwicklung einer Arthrose sowie den Versicherungsstatus beeinflusst und war unabhängig vom Patientenalter.

Abstract

Background

After controversial discussions in the literature about therapy regimens for calcaneal fractures, a retrospective study of patients operatively treated in a maximum care trauma center was conducted.

Objective

Investigation of the influencing factors on the treatment quality of operatively treated patients with calcaneal fractures.

Material and methods

Between 2005 and 2013 a total of 90 patients with calcaneal fractures were surgically treated in this hospital with locking plate osteosynthesis. A total of 48 patients with 55 fractures were retrospectively investigated. The assessment with respect to posttraumatic arthrosis was made radiologically and Böhler’s and Gissane’s angles were also determined. Clinically AOFAS and SF-36 scores were documented. The results were statistically tested with respect to possible risk factors.

Results

A total of 9 patients (18.8%) were found with complications necessitating operative revision, with 8 patients requiring subtalar arthrodesis and 1 patient with a deep wound infection. Nicotine abuse and a long interval between trauma and reconstructive surgery were identified as factors that influenced the development of wound healing problems. The average AOFAS score was 68 points and the SF-36 was 58.86 points. A poor result in the scores was caused by the development of symptomatic arthritis and the type of insurance. In this cohort factors, such as age and complexity of fractures were not correlated with a poor result.

Conclusion

In this patient collective nicotine abuse and a long interval between trauma and surgery were risk factors for development of wound infections. Other factors with an influence on the outcome were the postoperative development of arthritis and the type of health insurance; however, patient age had no impact on the outcome.

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Authors and Affiliations

  1. Klinik für Unfall‑, Hand- und Wiederherstellungschirurgie, Universitätsklinikum Münster, Albert-Schweitzer Campus 1, W1, 48149, Münster, Deutschland

    J. Evers, M. Oberste, D. Wähnert, N. Grüneweller, B. Wieskötter, A. Milstrey, M. J. Raschke & S. Ochman

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  1. J. Evers
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  2. M. Oberste
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Correspondence to J. Evers.

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Interessenkonflikt

J. Evers, M. Oberste, D. Wähnert, N. Grüneweller, B. Wieskötter, A. Milstrey, M.J. Raschke und S. Ochman geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

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W. Mutschler, München

H. Polzer, München

B. Ockert, München

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Evers, J., Oberste, M., Wähnert, D. et al. Outcome nach operativer Therapie von Kalkaneusfrakturen. Unfallchirurg 122, 778–783 (2019). https://doi.org/10.1007/s00113-018-0578-4

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