Objective To investigate the image characteristics of the intraarlicular calcaneal fracture combined with severe skin contusion. Methods From June 2001 to August 2010, 12 male patients with closed calcaneal nodule fractures combined with severe skin contusion, aged from 24 to 52 years old with a mean of 32 years old, were treated. The fractures included 5 cases in the left foot, 3 cases in the right foot, 4 cases with fall injury, 3 cases with sport injury, 1 case with other cause of injury, and 3 cases with diabetes. The time between injury and surgery was from 4h to 17 days, with an average of 12 days. All patients were being taken front and lateral X-ray and calcaneal axial CT. According to Sander classification, there were 5 cases in type Ⅱ and 3 cases in type Ⅲ. One patient was performed lateral expansion of routine incision. The remaining patients underwent local small incision, fracture reduction, and the use of 2 to 3 Steinmann pin fixation or hollow screw and absorbable screw fixation. One case was fixed with wire. Results The 12 patients were followed up for 9-20 months, with an average of 11 months. Postoperative skin and soft tissue necrosis occurred in 1 case, resulting in heel bone nodule exposure. It was recovered after delayed transplant with gastrocnemius flap. Injury of local soft tissue recovered well in the rest of the patients. The function of the. Achilles tendon recovered well. No postoperative wound infection and delayed healing. Occurred. Conclusion The imaging characteristics show that the fracture lines appear from anterior-superior to posterior-inferior on the lateral X-ray film, and associate with subtalar joint plate. The distal end of the fracture appears in open shape. These patients often combine with inside heel tubercle fracture.%目的 探讨跟骨后结节撕脱型骨折合并皮肤严重挫伤患者的影像学特点.方法 2001年6月～2010年8月,治疗12例男性闭合性跟骨后结节部骨折合并皮肤严重挫伤患者,年龄65～ 72岁,平均67岁；左足7例,右足5例；坠落伤8例,运动伤2例,其他原因损伤2例,其中3例合并糖尿病.受伤至手术时间4h～17天,平均11天.术前均对伤足摄正、侧位X线片及跟骨的CT轴位片.根据Sander分型,Ⅱ型5例,Ⅲ型3例.1例行外侧扩大切口,其余病例均行局部小切口治疗,骨折复位后利用2～3枚斯氏针固定,或用空心螺钉和可吸收螺钉固定,1例用钢丝固定.结果 12例患者获得随访,随访时间9～20个月,平均11个月.术后有1例软组织出现皮肤坏死,跟骨后结节骨质外露,二期行小腿腓肠神经营养皮瓣治愈,其余患者局部软组织损伤均恢复良好,患者跟腱功能恢复良好,术后伤口均无感染及延迟愈合.结论 影像学特点为:侧位X线片上骨折线呈前上至后下走向,均波及距下关节面,骨折远端分离呈开口状.本类患者多合并跟骨内侧结节骨折.
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