DOI: https://doi.org/10.22141/1608-1706.4.20.2019.178756

Therapeutic tactics in combined injuries of the posterior part of the foot

A.I. Bodnya

Abstract


Background. Combined fractures of calcaneus and talus bones in 35–43 % of cases occur in polytrauma. The small number of domestic and foreign literature publications indicates this problem to be still one of the most controversial. The purpose was to determine the features of the therapeutic tactics in patients with combined damages to the posterior part of the foot. Materials and methods. Twenty-three patients were observed, who had 51 injuries of the posterior part of the foot. First step-by-step there were performed metallic osteosynthesis of open (4) and closed (11) fractures of the talus with screws and wires, among them there were open (2) and closed (5) elimination of subtalar dislocation of the foot. Then instrumental reposition of the calcaneus by Westhues in our modification (7), percutaneous osteosynthesis by the device developed (2), combined (6) and external osteosynthesis with the plate (4) were performed. Functional results were analyzed using the AOFAS scale and determination of the foot pain index (FFI) 6 and 12 months after surgery. Results. The immediate and follow-up results of surgical treatment in 19 patients were studied. Comparison in the dynamics of the values of the questionnaire of the AOFAS scale showed increasing of differences in patients with lesions of the talus and calcaneal bones, depending on the duration of treatment, reaching to 12 months, 69.8 ± 5.9 and 74.7 ± 9.6 points, respectively. Comparison of the final values of the scale of the FFI questionnaire showed that a year after the injury there was a decrease in the index of the questionnaire, 4.5 ± 0.3 and 9.4 ± 0.3 points, respectively. The most positive indicators were noted in the dynamics in 9 patients with rammed foot dislocations on the AOFAS scale (95.8 ± 1.9 points), as well as in the FFI questionnaire (3.8 ± 0.1 points). In general, there was an expressed improvement in functional status of the foot a year after osteosynthesis (AOFAS 88.2 ± 7.8; FFI 8.2 ± 5.5). The total evaluation of positive results was 89.47 %, unsatisfactory — 10.53 %. Conclusions. Active surgical treatment tactics in case of injuries of the posterior part of the foot allow obtaining the best follow-up functional results.

Keywords


fracture of talus and calcaneus; subtalar dislocation of the foot; osteosynthesis

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