Prognostic value of objective examination of patients with intra-articular fractures of the calcaneus

Kulik N.G., Vashchenkov V.V., Khominets V.V., Ostapchenko A.A.

Abstract


IIntroduction The scope of examination of patients with closed intraarticular fractures of the calcaneus against the background of concomitant pathology
has been discussed up to date. The aim of the study was to improve the accuracy of predicting the nature of postoperative wound healing after osteosynthesis
of intra-articular fractures of the calcaneus from the extended lateral approach on the background of chronic obliterating diseases of the lower limb arteries
of different etiology, smoking and a combination of these factors. Material and methods Sixty-nine patients who were smokers and/or suffered from
chronic obliterating diseases with a total of 74 closed intra-articular fractures of the heel bones were analyzed. All patients received a comprehensive clinical
and instrumental examination consisting of radiography and computed tomography of the calcaneus to determine the proximal-distal gradient (PDG),
ankle-brachial index (ABI) and transcutaneous oximetry (TrOc). A single-factor analysis of variance was performed, after which an expert evaluation of
the features was performed, as well as testing of models with different sets of signs. Results The disperse analysis of variance in respect of 74 cases for the
relevant group of patients allowed us to obtain two models: the first with a level of statistical significance p0 less 0,001 (χ2 – 82,63; df = 7) and the predictive
efficiency of 97.3 % in regard to possible complications after open reduction with internal fixation; the second level of statistical significance p0 less 0,001
(χ2 – 34,76; df = 7) and prognostic effectiveness of 93,24 % related to the risk of repeated surgical interventions. Conclusions The proposed method of
predicting the development of complications in the immediate postoperative period after internal osteosynthesis of the calcaneus allows estimation of the
risks of complications by calculating PDG, ABI and TrOc with high efficiency (97.3 %). The proposed discriminant model predicts the need for repeated
surgical interventions with an efficiency of 93.24 %, and feasibility of surgical treatment with an extended lateral approach.

Keywords


intra-articular fracture of the calcaneus, transcutaneous oximetry, ankle-brachial index, immediate postoperative complications, chronic peripheral artery disease

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