Dr. Johney Juneja, Dr. Nitin Andrews, Dr. Gaurav Garg, Dr. Rahul Gorakh, Dr. Piyush, Dr. AK Mehra and Dr. Ramesh Sen
Objective: To evaluate the functional outcome and to study the advantages and disadvantages of open reduction and internal fixation of calcaneal fractures with plates using extensile lateral approach using Ankle Orthopaedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Score.
Methods: Our prospective study was conducted in Department of Orthopaedics, Ravindra Nath Tagore Medical College and Maharana Bhupal Hospital, Udaipur, Rajasthan between December 2021 to November 2022. Patients who attended Orthopaedics casualty and outpatient department with fracture of calcaneo were admitted and selected for the study based on inclusion and exclusion criteria. 30 patients were selected, informed written consent taken, evaluated preoperatively and operated and were followed up to 9 months. The functional outcome was assessed using AOFAS score.
Results: AOFAS Ankle-Hindfoot score was assessed at 3 months and 9 months follow up of all patients. At 3 months follow up, 20% of Sanders type II , 15% of Sanders type III, 14% of Sanders type IV showed a good score, 70% of Sanders type II, about 77% of Sanders type III and about 57% of Sanders type IV of cases showed a fair score. 10% in Sanders type II, 7% of Sanders type III, and about 28% in Sanders type IV showed a poor score.
At 9 months follow up of all patients, around 30% of Sanders type II, 15% of Sanders type III cases and 14% of Sanders type IV cases showed an excellent AOFAS score. 50% of Sanders type II, 62% of Sanders type III and 28% of Sanders type IV showed good AOFAS score. A total of 20% of Sanders type II, 15% of Sanders type III and 43% of Sanders type IV showed fair AOFAS score. Only 7 % of Sanders type III and 14 % of Sanders type IV showed poor AOFAS score.
Conclusion: The functional outcome after surgical management of calcaneal fractures were done at 3 months and 9 months using AOFAS Ankle-Hindfoot score and identified that majority of patients got good score. AOFAS Ankle Hindfoot scoring system was found to be effective in assessing the functional status of patients and the same was in accordance with previous studies. The advantages of extensile lateral approach for calcaneal fracture management include wide exposure of the calcaneus, allowing easier access to facet fragments, ability to decompress the lateral wall, exposure of the calcaneo-cuboid joint and sufficient area laterally for plate fixation. Disadvantages include injury to the blood supply of the lateral flap, difficulty with assessment of reduction of the medial wall and a higher incidence of wound problems occur with this approach.
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