medjournalМедицинский журналMedical Journal1818-426XБелорусский государственный медицинский университет10.51922/1818-426X.2026.2.35medjournal-423Research ArticleОБЗОРЫREVIEWSХирургическое лечение переломов пяточной костиSurgical treatment of calcaneal fracturesЛиЧж.LiZhengpeng

Минск

Minsk

СитникА. А.SitnikA. A.

Минск

Minsk

КорзунО. А.KorzunO. A.

Минск

Minsk

ГУ «Республиканский научно-практический центр травматологии и ортопедии»Republic Scientific and Practical Center for Traumatology and Orthopedics202623052026023543Copyright © Ли Ч., Ситник А.А., Корзун О.А., 20262026Ли Ч., Ситник А.А., Корзун О.А.Li Z., Sitnik A.A., Korzun O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://medjournal.ejournal.by/jour/article/view/423

Переломы пяточной кости являются нередкими повреждениями и представляют существенные трудности при лечении. Сложная форма пяточной кости требует применения специальных рентгенологических проекций (аксиальная, серия Broden) или выполнения компьютерной томографии для оценки тяжести костных повреждений и планирования лечения. Мягкие ткани пяточной области весьма чувствительны к повреждениям, выраженный отек и фликтены могут развиваться уже в течение нескольких часов после травмы. Это определяет высокие риски применения хирургических методов лечения до нормализации состояния мягких тканей, что может требовать отсрочки лечения на сроки до 1–2 недель после травмы. Консервативное лечение сопровождается высокой частотой сращений в неправильном положении и последующими функциональными ограничениями, сопоставимыми по выраженности с перенесенным инфарктом миокарда. Хирургическое лечение с применением расширенного наружного доступа обеспечивает возможность восстановления анатомии пяточной кости, однако (особенно при выполнении в поздние сроки после травмы) сопровождается существенной частотой трудных для лечения раневых осложнений. Одним из перспективных направлений развития является применение малоинвазивной прямой репозиции суставного компонента перелома через тарзальный доступ в сочетании с закрытой репозицией внесуставных компонентов повреждения. Однако имеющиеся литературные данные пока основываются на небольшом количестве наблюдений и требуют проведения собственных исследований в данном направлении.

Calcaneal fractures are not uncommon injuries. The treatment is accompanied by significant difficulties. Complex shape of the calcaneus requires special radiologic projections (axial, Broden series) or CT for the evaluation of injury and pre-operative planning. Soft-tissues in the calcaneal region are vulnerable to the injury, so extreme oedema and fracture blisters can develop within few hours after the injury. This makes surgical treatment dangerous for several days (up to two weeks after the injury) until the condition of the soft-issues becomes normal. Non-operative treatment is accompanied by high rate of malunions with subsequent significant functional impairments, comparable to those after myocardial infarction. Surgical treatment with extended lateral approach provides possibility of restoration of calcaneal anatomy, but for the cost of the high rate of wound complications, which are difficult to treat. One of perspective directions is the use of minimal tarsal approach for direct reduction of the posterior articular facet and closed reduction of the extra-articular fragments. Current evidences are based on small number of cases, thus further investigations in this direction shall be performed.

пяточная костьпереломыдиагностикахирургическое лечениерезультатыcalcaneusfracturediagnosticssurgical treatmentresultsReferencesRupp, M. The Incidence of Fractures Among the Adult Population of Germany–an Analysis From 2009 through 2019 / M. Rupp [et al.] // Dtsch Arztebl Int. Germany. – 2021. – Vol. 118, № 40. – P. 665–669.Rupp, M. The Incidence of Fractures Among the Adult Population of Germany–an Analysis From 2009 through 2019 / M. Rupp [et al.] // Dtsch Arztebl Int. Germany. – 2021. – Vol. 118, № 40. – P. 665–669.Rammelt, S. Fractures of the calcaneus: current treatment strategies / S. Rammelt, H. Zwipp // Acta Chir Orthop Traumatol Cech. Czech Republic. – 2014. – Vol. 81, № 3. – P. 177–196.Rammelt, S. Fractures of the calcaneus: current treatment strategies / S. Rammelt, H. Zwipp // Acta Chir Orthop Traumatol Cech. Czech Republic. – 2014. – Vol. 81, № 3. – P. 177–196.van Tetering, E. A. A. Functional outcome (SF-36) of patients with displaced calcaneal fractures compared to SF-36 normative data / E. A. A. van Tetering, R. E. Buckley // Foot ankle Int. United States. – 2004. – Vol. 25, № 10. – P. 733–738.van Tetering, E. A. A. Functional outcome (SF-36) of patients with displaced calcaneal fractures compared to SF-36 normative data / E. A. A. van Tetering, R. E. Buckley // Foot ankle Int. United States. – 2004. – Vol. 25, № 10. – P. 733–738.Rammelt, S. Calcaneal Fractures-Which Approach for Which Fracture? / S. Rammelt, M. P. Swords // Orthop Clin North Am. United States. – 2021. – Vol. 52, № 4. – P. 433–450.Rammelt, S. Calcaneal Fractures-Which Approach for Which Fracture? / S. Rammelt, M. P. Swords // Orthop Clin North Am. United States. – 2021. – Vol. 52, № 4. – P. 433–450.Корзун, О. А. Лечение многооскольчатых высокоэнергетичных переломов пяточной кости / О. А. Корзун, А. А. Ситник, А. Л. Линов, О. Н. Бондарев // Военная медицина. – 2014. – Т. 4, № 33. – С. 29–35.Korzun, А. Lechenije mnogooskolchatych vysokoenergetychnych perelomov pyatochnj kosti [The treatment of comminuted high-energy calcaneal fractures] / А. Korzun, А. Sitnik, А. Linov, A. Bondarau // Vojennaja medicina. – 2014. – Vol. 4, № 33. – P. 29–35 [In Russian].Allegra, P. R. Intra-articular Calcaneus Fractures: Current Concepts Review / P. R. Allegra [et al.] // Foot ankle Orthop. United States. – 2020. – Vol. 5, № 3. – P. 1–11.Allegra, P. R. Intra-articular Calcaneus Fractures: Current Concepts Review / P. R. Allegra [et al.] // Foot ankle Orthop. United States. – 2020. – Vol. 5, № 3. – P. 1–11.Essex-Lopresti, P. The mechanism, reduction technique, and results in fractures of the OS calcis / P. Essex-Lopresti // Br J Surg. England. – 1952. – Vol. 39, № 157. – P. 395–419.Essex-Lopresti, P. The mechanism, reduction technique, and results in fractures of the OS calcis / P. Essex-Lopresti // Br J Surg. England. – 1952. – Vol. 39, № 157. – P. 395–419.Sanders, R. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification / R. Sanders [et al.] // Clin Orthop Relat Res. United States. – 1993. – № 290. – P. 87–95.Sanders, R. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification / R. Sanders [et al.] // Clin Orthop Relat Res. United States. – 1993. – № 290. – P. 87–95.Busel, G. Quality of Reduction of Displaced Intra-articular Calcaneal Fractures Using a Sinus Tarsi Versus Extensile Lateral Approach / G. Busel [et al.] // J Orthop Trauma. United States. – 2021. – Vol. 35, № 6. – P. 285–288.Busel, G. Quality of Reduction of Displaced Intra-articular Calcaneal Fractures Using a Sinus Tarsi Versus Extensile Lateral Approach / G. Busel [et al.] // J Orthop Trauma. United States. – 2021. – Vol. 35, № 6. – P. 285–288.Fischer, S. Surgical experience as a decisive factor for the outcome of calcaneal fractures using locking compression plate: results of 3 years / S. Fischer [et al.] // Arch Orthop Trauma Surg. Germany. – 2021. – Vol. 141, № 10. – P. 1691–1699.Fischer, S. Surgical experience as a decisive factor for the outcome of calcaneal fractures using locking compression plate: results of 3 years / S. Fischer [et al.] // Arch Orthop Trauma Surg. Germany. – 2021. – Vol. 141, № 10. – P. 1691–1699.Wilkinson, B. G. Minimally Invasive Treatment of Displaced Intra-Articular Calcaneal Fractures / B. G. Wilkinson, J. L. Marsh // Orthop Clin North Am. United States. – 2020. – Vol. 51, № 3. – P. 325–338.Wilkinson, B. G. Minimally Invasive Treatment of Displaced Intra-Articular Calcaneal Fractures / B. G. Wilkinson, J. L. Marsh // Orthop Clin North Am. United States. – 2020. – Vol. 51, № 3. – P. 325–338.Buckley, R. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial / R. Buckley [et al.] // J Bone Joint Surg Am. United States. – 2002. – Vol. 84, № 10. – P. 1733–1744.Buckley, R. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial / R. Buckley [et al.] // J Bone Joint Surg Am. United States. – 2002. – Vol. 84, № 10. – P. 1733–1744.Sharr, P. J. Current management options for displaced intra-articular calcaneal fractures: Non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review / P. J. Sharr [et al.] // Foot ankle Surg Off J Eur Soc Foot Ankle Surg. France. – 2016. – Vol. 22, № 1. – P. 1–8.Sharr, P. J. Current management options for displaced intra-articular calcaneal fractures: Non-operative, ORIF, minimally invasive reduction and fixation or primary ORIF and subtalar arthrodesis. A contemporary review / P. J. Sharr [et al.] // Foot ankle Surg Off J Eur Soc Foot Ankle Surg. France. – 2016. – Vol. 22, № 1. – P. 1–8.Agren, P.-H. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial / P.-H. Agren, P. Wretenberg, A. S. Sayed-Noor // J Bone Joint Surg Am. United States. – 2013. – Vol. 95, № 15. – P. 1351–1357.Agren, P.-H. Operative versus nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial / P.-H. Agren, P. Wretenberg, A. S. Sayed-Noor // J Bone Joint Surg Am. United States. – 2013. – Vol. 95, № 15. – P. 1351–1357.Gotha, H. E. Current Controversies in Management of Calcaneus Fractures / H. E. Gotha, J. R. Zide // Orthop Clin North Am. United States. – 2017. – Vol. 48, № 1. – P. 91–103.Gotha, H. E. Current Controversies in Management of Calcaneus Fractures / H. E. Gotha, J. R. Zide // Orthop Clin North Am. United States. – 2017. – Vol. 48, № 1. – P. 91–103.Коробушкин, Г. В. Малоинвазивный остеосинтез в лечении переломов пяточной кости / Г. В. Коробушкин, А. В. Скороглядов, К. А. Егиазарян, Е. А. Мирошникова, О. А. Дмитриев, М. А. Королев // Московский Хирургический Журнал. – 2013. – Т. 31, № 3. – P. 42–45.Korobushkin, G. Maloinvazivnyj osteosintez v lechenii perelomov pyatochnoy kosti [Minimsally invasive osteosynthesis in the treatment of calcaneal fractures] / G. Korobushkin, A. Skorogliadov, K. Egiazaryan, Е. Miroshnikova, О. Dmitriev, М. Korolev // Moskovskiy Hirurgicheskij Zhurnal. – 2013. – Vol. 31, № 3. – P. 42–45 [In Russian].Zwipp, H. Osteosynthese dislozierter intraarticulaerer Kalkaneusfrakturen / H. Zwipp [et al.] // Oper Orthop Traumatol. Germany. – 2013. – Vol. 25, № 6. – P. 554–568.Zwipp, H. Osteosynthese dislozierter intraarticulaerer Kalkaneusfrakturen / H. Zwipp [et al.] // Oper Orthop Traumatol. Germany. – 2013. – Vol. 25, № 6. – P. 554–568.Корзун, О. А. Минимально инвазивный и открытый остеосинтез в лечении внутрисуставных переломов пяточной кости / О. А. Корзун, А. А. Ситник, А. Л. Линов, С. И. Худницкий // Медицинские новости. – 2015. – № 8. – P. 16–20.Korzun, A. Minimalno invasivnyj i otkrytyj osteosyntez v lechenii vnutrisustavnych perelomov pyatochnoj kosti [Minimally invasive and open osteosynthesis in the treatment of the intraarticular calcaneal fractures] / A. Korzun, А. Sitnik, А. Linov, S. Hudnizkiy // Medizinskije novosti. – 2015. – Vol. 8. – P. 16–20 [In Russian].Berberian, W. Displacement of the sustentacular fragment in intra-articular calcaneal fractures / W. Berberian [et al.] // J Bone Joint Surg Am. United States. – 2013. – Vol. 95, № 11. – P. 995–1000.Berberian, W. Displacement of the sustentacular fragment in intra-articular calcaneal fractures / W. Berberian [et al.] // J Bone Joint Surg Am. United States. – 2013. – Vol. 95, № 11. – P. 995–1000.Gitajn, I. L. Anatomic Alignment and Integrity of the Sustentaculum Tali in Intra-Articular Calcaneal Fractures: Is the Sustentaculum Tali Truly Constant? / I. L. Gitajn [et al.] // J Bone Joint Surg Am. United States. – 2014. – Vol. 96, № 12. – P. 1000–1005.Gitajn, I. L. Anatomic Alignment and Integrity of the Sustentaculum Tali in Intra-Articular Calcaneal Fractures: Is the Sustentaculum Tali Truly Constant? / I. L. Gitajn [et al.] // J Bone Joint Surg Am. United States. – 2014. – Vol. 96, № 12. – P. 1000–1005.Nosewicz, T. L. A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures / T. L. Nosewicz [et al.] // Foot ankle Surg Off J Eur Soc Foot nkle Surg. France. – 2019. – Vol. 25, № 5. – P. 580–588.Nosewicz, T. L. A systematic review and meta-analysis of the sinus tarsi and extended lateral approach in the operative treatment of displaced intra-articular calcaneal fractures / T. L. Nosewicz [et al.] // Foot ankle Surg Off J Eur Soc Foot nkle Surg. France. – 2019. – Vol. 25, № 5. – P. 580–588.Park, C. H. Randomized comparative study between extensile lateral and sinus tarsi approaches for the treatment of Sanders type 2 calcaneal fracture / C. H. Park, H. Yan, J. Park // Bone Joint J. England. – 2021. – Vol. 103-B, № 2. – P. 286–293.Park, C. H. Randomized comparative study between extensile lateral and sinus tarsi approaches for the treatment of Sanders type 2 calcaneal fracture / C. H. Park, H. Yan, J. Park // Bone Joint J. England. – 2021. – Vol. 103-B, № 2. – P. 286–293.Yu, T. Comparison of sinus tarsi approach and extensile lateral approach for calcaneal fractures: A systematic review of overlapping meta-analyses / T. Yu [et al.] // J Orthop Surg (Hong Kong). England. – 2020. – Vol. 28, № 2. – P. 2309499020915282.Yu, T. Comparison of sinus tarsi approach and extensile lateral approach for calcaneal fractures: A systematic review of overlapping meta-analyses / T. Yu [et al.] // J Orthop Surg (Hong Kong). England. – 2020. – Vol. 28, № 2. – P. 2309499020915282.Hu, Y. Emergency surgery of intra-articular calcaneal fractures using sinus tarsi approach with modified reduction technique / Y. Hu [et al.] // BMC Musculoskelet Disord. England. – 2023. – Vol. 24, № 1. – P. 523.Hu, Y. Emergency surgery of intra-articular calcaneal fractures using sinus tarsi approach with modified reduction technique / Y. Hu [et al.] // BMC Musculoskelet Disord. England. – 2023. – Vol. 24, № 1. – P. 523.Sugimoto, T. Plate fixation through the lateral extensile approach versus cannulated screw fixation through the sinus tarsi approach for calcaneal fracture: a multicenter, propensityscore-matched TRON study / T. Sugimoto [et al.] // Eur J Orthop Surg Traumatol. France. – 2022. – Vol. 32, № 7. – P. 1333–1340.Sugimoto, T. Plate fixation through the lateral extensile approach versus cannulated screw fixation through the sinus tarsi approach for calcaneal fracture: a multicenter, propensityscore-matched TRON study / T. Sugimoto [et al.] // Eur J Orthop Surg Traumatol. France. – 2022. – Vol. 32, № 7. – P. 1333–1340.Ahn, J. Learning Curve for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fracture by Extensile Lateral Approach Using the Cumulative Summation Control Chart / J. Ahn [et al.] // Foot ankle Int. United States. – 2019. – Vol. 40, № 9. – P. 1052–1059.Ahn, J. Learning Curve for Open Reduction and Internal Fixation of Displaced Intra-articular Calcaneal Fracture by Extensile Lateral Approach Using the Cumulative Summation Control Chart / J. Ahn [et al.] // Foot ankle Int. United States. – 2019. – Vol. 40, № 9. – P. 1052–1059.Schepers, T. Similar Anatomical Reduction and Lower Complication Rates With the Sinus Tarsi Approach Compared With the Extended Lateral Approach in Displaced Intra-Articular Calcaneal Fractures / T. Schepers [et al.] // J Orthop Trauma. United States. – 2017. – Vol. 31, № 6. – P. 293–298.Schepers, T. Similar Anatomical Reduction and Lower Complication Rates With the Sinus Tarsi Approach Compared With the Extended Lateral Approach in Displaced Intra-Articular Calcaneal Fractures / T. Schepers [et al.] // J Orthop Trauma. United States. – 2017. – Vol. 31, № 6. – P. 293–298.

The authors declare that there are no conflicts of interest present.