Le fratture del calcagno: fissazione esterna
Tóm tắt
The treatment of calcaneal fractures remains controversial. Several techniques have been described since 1900 (traction techniques, less-invasive techniques, open techniques). In intra-articular fractures no treatment has been shown to be superior to others. To date, open reduction with internal fixation through a side access has represented the gold standard in the treatment of this type of injury, owing to the possibility of reducing articular fragments. Minimally invasive techniques are generally used only with exposed fractures. For some time now, minimally invasive techniques have become remarkably popular, especially when the need arises to treat patients with severe soft tissue damage and local or systemic diseases, in whom the classical open technique is contraindicated. We use the Ilizarov technique or a mini external fixator, with 6 chips, which produce a distraction to three points in the longitudinal, angular and cranio-caudal directions. The surgical technique provides closed or minimally invasive reduction, under scopic control. Then Kirschner, chips and external fixator are positioned, with distraction, if necessary. These techniques, such as external fixation, were born to associate the benefits of surgical reduction and stable fixation with those of a minimally invasive technique. In addition to a purely clinical discussion, the use of external fixation proved to be a mechanically sound system able to anticipate and grant the possibility of earlier load after surgery. We think that fixators mechanically express their function by crystallizing the position of fragments and by making the calcaneus a single body, thus maintaining the volume of the calcaneus. This leads to advantages that could be correlated with a positive clinical outcome, because the foot is not subtracted from the load during long periods. These techniques also allow for early mobilization of the neighbouring joint districts, and fixation devices are easy to remove.
Tài liệu tham khảo
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