Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures | Revista Española de Cirugía Ortopédica y Traumatología (English Edition)

array:24 ["pii" => "S1988885618300373" "issn" => "19888856" "doi" => "10.1016/j.recote.2018.04.007" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "734" "copyright" => "SECOT" "copyrightAnyo" => "2018" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2018;62:267-73" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S188844151830016X" "issn" => "18884415" "doi" => "10.1016/j.recot.2018.01.010" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "734" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2018;62:267-73" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 184 "formatos" => array:2 [ "HTML" => 128 "PDF" => 56 ] ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original" "titulo" => "Tratamiento de las fracturas intraarticulares de calcáneo mediante placa de reconstrucción. Resultados y complicaciones de 86 fracturas" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "267" "paginaFinal" => "273" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 647 "Ancho" => 1800 "Tamanyo" => 88393 ] ] "descripcion" => array:1 [ "es" => "Progresión de una fractura tipoIV de Sanders a una artrodesis subastragalina tras osteosíntesis primaria." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Diranzo-García, X. Bertó-Martí, L. Castillo-Ruiperez, V. Estrems-Díaz, L. Hernández-Ferrando, J. Villodre-Jiménez, A. Bru-Pomer" "autores" => array:7 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Diranzo-García" ] 1 => array:2 [ "nombre" => "X." "apellidos" => "Bertó-Martí" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Castillo-Ruiperez" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Estrems-Díaz" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Hernández-Ferrando" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Villodre-Jiménez" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Bru-Pomer" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1988885618300373" "doi" => "10.1016/j.recote.2018.04.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300373?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S188844151830016X?idApp=UINPBA00004N" "url" => "/18884415/0000006200000004/v1_201807050410/S188844151830016X/v1_201807050410/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S1988885618300361" "issn" => "19888856" "doi" => "10.1016/j.recote.2018.04.006" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "729" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2018;62:274-81" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4 "formatos" => array:2 [ "HTML" => 2 "PDF" => 2 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Are Modic changes in patients with chronic low back pain indicative of a worse clinical course? 10 years of follow-up" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "274" "paginaFinal" => "281" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Supone la presencia de cambios Modic en pacientes con dolor lumbar crónico una peor evolución clínica y una mayor posibilidad de precisar cirugía? Evolución a 10 años" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1323 "Ancho" => 2519 "Tamanyo" => 129753 ] ] "descripcion" => array:1 [ "en" => "Graphical representation using boxplot of lumbar VAS and in the leg in patients with/without type changes." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "L.M. Romero-Muñoz, A. Barriga-Martín, A. Segura-Fragoso, C. Martín-González" "autores" => array:4 [ 0 => array:2 [ "nombre" => "L.M." "apellidos" => "Romero-Muñoz" ] 1 => array:2 [ "nombre" => "A." "apellidos" => "Barriga-Martín" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Segura-Fragoso" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Martín-González" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441518300110" "doi" => "10.1016/j.recot.2018.01.005" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441518300110?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300361?idApp=UINPBA00004N" "url" => "/19888856/0000006200000004/v1_201807060854/S1988885618300361/v1_201807060854/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1988885618300385" "issn" => "19888856" "doi" => "10.1016/j.recote.2018.04.008" "estado" => "S300" "fechaPublicacion" => "2018-07-01" "aid" => "735" "copyright" => "SECOT" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Rev Esp Cir Ortop Traumatol. 2018;62:257-66" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Technical aspects and complications in the surgical treatment of poliomyelitis-affected lower limb fractures" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "257" "paginaFinal" => "266" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Aspectos técnicos y complicaciones en el tratamiento de las fracturas de los miembros inferiores con secuelas de poliomielitis" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1510 "Ancho" => 2333 "Tamanyo" => 369892 ] ] "descripcion" => array:1 [ "en" => "Neck of the femur fracture treated with total hip replacement with intraoperative instability (A–C). Periprosthetic fracture treated with plate (D–H). Intraoperative iatrogenic fracture (E, arrow)." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "J. Mingo-Robinet, J.A. Alonso, M. Moreno-Barrero, L. González-García, V. Garcia-Virto, H.J. Aguado" "autores" => array:6 [ 0 => array:2 [ "nombre" => "J." "apellidos" => "Mingo-Robinet" ] 1 => array:2 [ "nombre" => "J.A." "apellidos" => "Alonso" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Moreno-Barrero" ] 3 => array:2 [ "nombre" => "L." "apellidos" => "González-García" ] 4 => array:2 [ "nombre" => "V." "apellidos" => "Garcia-Virto" ] 5 => array:2 [ "nombre" => "H.J." "apellidos" => "Aguado" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1888441518300171" "doi" => "10.1016/j.recot.2018.01.011" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441518300171?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300385?idApp=UINPBA00004N" "url" => "/19888856/0000006200000004/v1_201807060854/S1988885618300385/v1_201807060854/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original Article" "titulo" => "Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "267" "paginaFinal" => "273" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "J. Diranzo-García, X. Bertó-Martí, L. Castillo-Ruiperez, V. Estrems-Díaz, L. Hernández-Ferrando, J. Villodre-Jiménez, A. Bru-Pomer" "autores" => array:7 [ 0 => array:4 [ "nombre" => "J." "apellidos" => "Diranzo-García" "email" => array:1 [ 0 => "pdiranzo@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "X." "apellidos" => "Bertó-Martí" ] 2 => array:2 [ "nombre" => "L." "apellidos" => "Castillo-Ruiperez" ] 3 => array:2 [ "nombre" => "V." "apellidos" => "Estrems-Díaz" ] 4 => array:2 [ "nombre" => "L." "apellidos" => "Hernández-Ferrando" ] 5 => array:2 [ "nombre" => "J." "apellidos" => "Villodre-Jiménez" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Bru-Pomer" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento de las fracturas intraarticulares de calcáneo mediante placa de reconstrucción. Resultados y complicaciones de 86 fracturas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 647 "Ancho" => 1800 "Tamanyo" => 88621 ] ] "descripcion" => array:1 [ "en" => "Progression of Sanders type IV fracture to a subtalar arthrodesis following primary osteosynthesis." ] ] ] "textoCompleto" => "IntroductionThe bone most commonly injured in the tarsus is the calcaneus, accounting for between 1% and 2% of all fractures. Approximately 75% will be intraarticular, with 10% associated with fracture at rachis level and 26% other fractures at lower limb level.<a class="elsevierStyleCrossRefs" href="#bib0160">1,2</a>The great majority of these fractures occur in young people in a working environment, frequently due to haste or high energy accidents, leading to long sick leave and major socio-economic impact.<a class="elsevierStyleCrossRefs" href="#bib0170">3,4</a>Intraarticular calcaneal fractures are characterised by current controversy regarding their treatment, since many different solutions and opinions may be encountered for the same fracture.<a class="elsevierStyleCrossRef" href="#bib0180">5</a> However, although authors in the literature agree that available evidence is insufficient to state that surgical treatment is superior to conservative treatment,<a class="elsevierStyleCrossRefs" href="#bib0185">6,7</a> the current trend is for open reduction and internal fixation.<a class="elsevierStyleCrossRefs" href="#bib0195">8–10</a> Due to orthopaedic surgeons’ fear of the complications described for surgical wounds using the “extended L shaped lateral approach” considered the gold standard surgery,<a class="elsevierStyleCrossRef" href="#bib0160">1</a> minimally invasive techniques are now increasing. Described outcomes are favourable although technically these techniques are more demanding and require a greater learning curve.<a class="elsevierStyleCrossRef" href="#bib0210">11</a>The objectives of surgical treatment are to restore the three-dimensional anatomy of the calcaneus (in height, length and width) and the anatomical reduction of the joint surfaces. Finally, functional restoration is sought as soon as possible, with a stable osteosynthesis.<a class="elsevierStyleCrossRefs" href="#bib0160">1,12–14</a>Therefore, given the gravity and complexity of this type of injury, associated with the rate of surgical complications and physical sequelae it may entail, calcaneal fractures continue to be a genuine challenge for the orthopaedic surgeon. The aim of our study is to assess the result of surgical treatment of intraarticular calcaneal fractures, and to analyse the variables which have an influence on obtaining these results. We therefore conducted an retrospective observational study in patients who had undergone surgery for intraarticular calcaneal fractures.Material and methodsBetween August 2006 and March 2016 a total of 97 consecutive calcaneal fractures were performed in 88 patients (9 bilateral fractures) using an extended lateral “L-shaped” approach and a low profile reconstruction plate. We excluded from the study all patients with fractures which were considered conservative and we included all patients who underwent surgery using the said technique. Ten patients were lost to follow-up: 2 (2.3%) died from non-surgical causes; 3 (3.4%) were patients who were inmates in a prison, who were transferred to centres outside of our healthcare area, and we were unable to locate 5 patients (5.7%). The final sample included 78 patients and 86 intraarticular calcaneal fractures (8 patients with bilateral surgery) whose clinical and radiologic follow-up has been retrospectively analysed.Out of the 78 patients, 56 (71.8%) were male and 22 (28.2%) female. Mean age at surgery was 48±12.24 years. A total of 53 patients (67.9%) presented with associated comorbidity: 38 patients (48.7%) with a tobacco habit; 20 (25.6%) with a history of psychiatric disorders; 13 (16.7%) with drug or alcohol abuse; 13 (16.7%) with chronic use of corticosteroids; 8 (10.3%) with diabetes mellitus and 8 (10.3%) with infectious-contagious diseases (HIV or hepatitis B or C).With regard to the production mechanism, 44 (56.4%) of patients suffered from falls of under 3m height and 22 (28.2%) of over 3m. Ten patients (12.8%) presented with fractures after ankle sprain or banal trauma and 2 patients (2.6%) after high energy traffic accidents. Nineteen patients (24.4%) presented with associated fractures: 9 (11.5%) with fractures at rachis level; 9 (11.5%) with fractures in lower limbs; 8 (10.3%) in upper limbs and 3 (3.8%) at pelvic level. Seventeen patients (21.8%) had fractures of both heel bones, and 8 of them underwent bilateral surgery.All the fractures were classified in accordance with Sanders<a class="elsevierStyleCrossRef" href="#bib0230">15</a> classification, based on computerised tomography imaging (CAT), resulting in 12 (15%) type II fractures, 54 (62.8%) type III and 20 (23.2%) type IV (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). We measured the Böhler and Gissane angles on the lateral radiographies, obtaining a preoperative mean Böhler angle of 17.1±7.29° and a preoperative mean Gissane angle of 83.3±11.4°.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Surgical techniqueAll cases were operated on by the same surgical team. 80.2% of patients were operated on during the first 15 days after the fracture (range between 4 and 22 days), provided that the state of the soft tissues was optimal and the wrinkle test positive. Mean time in surgery was 132±33min. Surgery was performed with the patient in lateral decubitus position, lower extremity ischaemia positioned at thigh level and with intraoperative fluoroscopy control (profile, axial and Broden projections). In order to do this, in all cases, we used the “extended lateral L shaped approach” proposed by Palmer and Letournel and later modified by Benirschke.<a class="elsevierStyleCrossRefs" href="#bib0235">16–18</a> We made a complete flap protecting the sural nerve and the peroneal tendons. The fracture was reduced after removal of the side wall (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A), beginning with the anterior tuberosity and continuing through the anteromedial articular facets and subtalar joint, finishing in the posterior tuberosity, with provisional attachment using Kirschner needles and with accurate three-dimensional reconstruction of the calcaneus and articular surfaces confirmed by fluoroscopy. After this, after repositioning the side wall in its anatomic location, fixation was performed low profile plates in all cases with non-blocking nails (Synthes Locking Calcaneal Plate®, Synthes USA, Paoli, USA) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B). We inserted a Redon type aspiration drainage system in all patients, which was removed after 48h if it had not been productive. Partial weight bearing was not permitted until the sixth week and complete weight bearing until the 12th week.<elsevierMultimedia ident="fig0005"></elsevierMultimedia>Postoperative evaluationAll patients were assessed at 4 weeks, 8 weeks, 3 months, 6 months and subsequently annually for clinical examination and radiographic follow-up. Standard evaluation in each visit included the American Orthopaedic Foot and Ankle Society Score (AOFAS),<a class="elsevierStyleCrossRefs" href="#bib0250">19,20</a> taking the score obtained in the last patient check-up in the last consultation considered as the final follow-up. We then analysed the relationship between the score from the AOFAS and each of the different variables: gender, age, presence of comorbidity (tobacco habit, drug or alcohol abuse, a history of psychiatric disorders, diabetes, chronic intake of corticosteroids or infectious and contagious diseases), bilaterality or unilaterality of concomitant fractures, lesional mechanism and classification of fracture according to Sanders. We finally compared the post-surgical radiologic results in the last check up to the preoperative studies by measuring the Böhler and Gissane angles, and we analysed their relationship to final functional results.Statistical analysisData analysis was performed using the SPSS 22 statistical programme for MAC OS (version 22; SPSS, Chicago, IL, USA). We made a descriptive analysis, expressing the qualitative variables such as absolute and relative frequencies and the quantitative variables such as the mean and standard deviation (SD). We conducted a bivariate study, using the parametric Fisher Student's t-test for the quantitative variables and the non-parametric Mann–Whitney U test for normality of distribution, the parametric Chi-squared test for the qualitative variables and the exact Fisher test for the non-parametric test. The significance level was established at 5%.ResultsMean follow-up time of the 86 cases (78 patients) was 55±25 months.Clinical and radiologic results. The mean AOFAS score obtained was 73.9±10.2 points out of 100 (95% CI: 74.49–78.95 points), with excellent results (90–100 points) in 8 cases (9.3%), good (75–89 points) in 40 (47.7%), acceptable (50–74 points) in 35 (39.5%) and poor (0–49 points) inn 3 cases (3.5%).The mean postoperative Böhler angle was 27.2±9.1°, and Gissane angle was 118.6±12.02°. We achieved a restoration of the Böhler angle (between 20° and 40°) in 60 patients (69.8%).All patients had presented with a complete fracture consolidation at the 6 month check up after surgery. 36 cases (42%) had developed subtalar joint arthrosis which were all found using CAT. In 11 (12.8%), it was necessary to perform subtalar arthrodesis, which was in one of the 12 cases made with Sanders type II fractures (8%), in 5 of the 54 cases with Sanders type III fractures (9%), and in 5 of the 20 cases with Sanders type IV fractures (25%) (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).<elsevierMultimedia ident="fig0010"></elsevierMultimedia>Complications. Thirteen patients (20.5%) presented with a total of 16 complications; 12 cases (14%) of complications at surgical wound level, 5 (5.8%) cases of superficial infection, treated with surgical cleaning and extraction of osteosynthesis material in 4 cases; 3 patients (3.4%) developed a deep infection or osteomyelitis, all of which were treated with aggressive debridement, extraction of the osteosynthesis material and filling of the defect with antibiotic bone cement. In 2 of these 3 patients, two-stage arthrodesis was performed. In 4 cases (4.7%) a defect in the wound closure occurred without the infection being diagnosed, with treatment being carried out in collaboration with the Ulcer Unit through the application of vacuum therapy. However, in one subject it was necessary to remove the osteosynthesis material and to make a flap closure using plastic surgery. Two patients (2.3%) presented with a neuropathy of the sural nerve; there was one case (1.2%) of Sudeck algodystrophy and one case (1.2%) of calcification at peroneal tendon level treated with surgical tenolysis.Analysis of resultsStatistical analysis did not reveal any statistically significant differences (p>0.05) in the functional results obtained in the AOFAS test with respect to gender, patients with unilateral fractures versus bilateral, patients with other concomitant fractures or the cohort of patients under 60 compared with those over 60. Neither did we find any significant association between the patients who presented with an associated comorbidity with functional results (p>0.05) or the appearance of complications during follow-up (p>0.05). However, we did obtain significantly better results in patients with falls under 3m height compared with patients with falls of over 3m height or high energy accidents (p=0.029); the cohort of patients under 30 (p=0.037), and patients with Sanders type II and II fractures compared with Sanders type IV fractures (p=0.001). In contrast, we did not find results were better if we compared the patients with Sanders type II fractures to those with type III fractures (p=0.963). The mean difference of the Böhler and Gissane angles was 10.1° (95% CI: 4.3–12.1°) and of 35.3° (95% CI: 29.4–39.1°) respectively, with this improvement being significant (p=0.023 and p=0.014) (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>). We did not find any better functional results in the cohort of patients where a reduction in the Böhler angle was obtained (20–40°) (p>0.05).<elsevierMultimedia ident="tbl0010"></elsevierMultimedia>DiscussionAt present there is a tendency among orthopaedic surgeons use surgical treatment for intraarticular calcaneal fractures and specifically open reduction and fixation with a plate with “extended lateral L-shaped approach”.<a class="elsevierStyleCrossRefs" href="#bib0160">1,6,8–10</a> Despite this, evidence is insufficient in the literature to support better surgical treatment outcome as opposed to conservative treatment.<a class="elsevierStyleCrossRefs" href="#bib0185">6,7</a> In our environment, intraarticular calcaneal fractures are of the few intraarticular fractures which have usually been treated conservatively in a high percentage of cases, specifically 57.98%. This result was obtained through a survey carried out in 29 Spanish hospitals and with a total of 624 fractures.<a class="elsevierStyleCrossRef" href="#bib0260">21</a> This was due to technical complexity and especially to the fear of developing any of the described complications, and in particular those relating to surgical wounds.<a class="elsevierStyleCrossRef" href="#bib0260">21</a> The progression of a subtalar arthrosis was therefore unavoidable due to the unacceptable residual articular congruence, accompanied on many occasions by a non-union with three-dimensional anatomical change of the hindfoot.<a class="elsevierStyleCrossRefs" href="#bib0205">10,21–23</a> In their recent meta analysis Luo et al.<a class="elsevierStyleCrossRef" href="#bib0190">7</a> concluded that surgical treatment is not superior to conservative treatment but, despite the lower rate of complications in non-surgical treatment, the risk of subtalar arthrodesis is much higher. In a prospective, randomised controlled study Buckley et al.<a class="elsevierStyleCrossRef" href="#bib0200">9</a> compared the outcome of surgical treatment to conservative treatment, obtaining better clinical results in those patients where anatomical reduction had been achieved, and particularly in those who did not present with occupational disputes. The patients who were conservatively managed were 5.5 times more likely to be operated on again with subtalar arthrodesis. Similarly, Howard et al.<a class="elsevierStyleCrossRef" href="#bib0275">24</a> demonstrated that the patients who had been treated conservatively had five times more risk of subtalar arthrodesis compared to those who underwent surgery. In their study Brauer et al.<a class="elsevierStyleCrossRef" href="#bib0170">3</a> demonstrated a more favourable outcome in cost-effective analysis for surgical treatment. For their part, Radnay et al.<a class="elsevierStyleCrossRef" href="#bib0265">22</a> concluded that arthrodesis was highly complicated in cases which had initially been treated conservatively, demonstrating better outcome and a lower rate of complications in patients who had been treated surgically from the beginning, provided that anatomical parameters had been correctly restored.In our series, on subdividing the sample according to the type of fracture, we observed that the patients with Sanders type IV fractures presented with poorer clinical outcome than those with types II and III, with scores on the postoperative AOFAS scale of 67.9 points for type IV and 79.5 and 78.1 points for type II and III, respectively. A quarter of cases with Sanders type IV fractures required subtalar arthrodesis compared with 8% and 9% of types II and III, respectively, thereby tripling the risk of arthrodesis. Csziy et al.<a class="elsevierStyleCrossRef" href="#bib0280">25</a> concluded in their study that Sanders type IV fractures had 5.5 times more possibilities of developing subtalar arthrosis. The worst prognosis of Sanders type IV fractures, and of the patients who presented with high energy trauma was due firstly to higher complexity in achieving anatomical reduction of the joint and secondly to the poor viability of the joint cartilage after the initial high energy impact,<a class="elsevierStyleCrossRefs" href="#bib0160">1,12,22,26</a> responsible for the post-traumatic joint degeneration, which was irreversible in the medium and long term, regardless of the reduction obtained.There is currently no consensus regarding the treatment of Sanders type IV fractures. Several authors recommend primary subtalar arthrodesis,<a class="elsevierStyleCrossRefs" href="#bib0230">15,27</a> whilst others advocate primary osteosynthesis as having acceptable outcomes.<a class="elsevierStyleCrossRef" href="#bib0265">22</a> Schepers<a class="elsevierStyleCrossRef" href="#bib0295">28</a> published a systematic review of results after primary arthrodesis with excellent outcomes. However, Buckley et al.<a class="elsevierStyleCrossRef" href="#bib0200">9</a> compared the results obtained after primary osteosynthesis to those of primary arthrodesis and found no major improvement in favour of either technique. In contrast, primary arthrodesis is recommended in patients who seek faster functional recovery in their occupational environment and to avoid possible two-stage surgery, with the financial benefit this entails. In our centre, given the results obtained in Sanders type IV fractures, we decided to initially perform osteosynthesis since 3 out of every 4 patients who underwent surgery did not require subtalar arthodesis. Furthermore, we consider it is more technically complex to carry out primary arthodesis as final treatment, because the need to anatomically reconstruct the calcaneus with stable assemblage in addition to the use of necessary bone grafting to achieve arthrodesis, thus increasing time in surgery and potential complications.The main problem associated with the “extended L-shaped lateral approach” are surgical wound level complications and the rates of these vary between 19% and 23% in the 3 most widely published series.<a class="elsevierStyleCrossRefs" href="#bib0185">6,9,29</a> In their series Buckley et al.<a class="elsevierStyleCrossRef" href="#bib0200">9</a> present 17% superficial and 5% deep surgical wound complications. Griffin et al.<a class="elsevierStyleCrossRef" href="#bib0300">29</a> reported problems on the surgical wound level in 19% of cases. For their part, Agren et al.<a class="elsevierStyleCrossRef" href="#bib0185">6</a> presented superficial wound complications in 19% of cases and deep infections in 4% of cases. We had similar results in our series, treating these patients with the Ulcer Unit with vacuum therapy and performing primary surgery with as least trauma possible to the soft tissues, provided that the status of the soft tissues was optimum. In contrast with other authors,<a class="elsevierStyleCrossRefs" href="#bib0275">24,30</a> we found no direct relationship between comorbidities and functional outcome, nor with the appearance of complications, although it is true that the control exerted for this type of patient is much narrower.With regards to the limitations of our study, our case series was analysed descriptively and retrospectively, and is thus prone to the limitations this type of study. The follow-up period is relatively short and heterogeneous among the different patients, which does not allow for long-term evolution. In our study we did not control the interaction and confusion variables, and the differences found in the results could be due to the causes other than surgical treatment. Moreover, we did not make a comparative study with another surgical technique nor identify the intraarticular calcaneal fractures conservatively during this period. One of the advantages of our study is that the number of cases and their heterogeneity is representative for a unit dealing with this type of trauma on a regular basis.ConclusionsFrom the results obtained in our series, we may conclude that open reduction and internal fixation of intraarticular calcaneal fractures using the “extended L-shaped lateral approach” is a valid alternative. An accurate surgical technique and optimum care of soft tissues is vital due to the frequent surgical wound complications. From the results obtained, we believe that primary osteosynthesis in patients with Sanders IV type fractures is a valid option, although it must be performed by surgeons who are experienced in this technique.We believe the Sanders classification is an important prognostic factor, as is the lesional mechanism and age of the patients. Poorer functional outcome presents in patients with Sanders type IV fractures, with high energy traumas and the cohort of patients over 30 years of age compared with those under 30. Similarly to Biz et al.<a class="elsevierStyleCrossRef" href="#bib0310">31</a> we found no correlation between the anatomical reduction of the Böhler angle and functional results. For this reason, we believe that this angle has no predictive value as a measurement for outcome following surgery.Level of evidenceLevel of evidence IV.Ethical disclosuresProtection of human and animal subjectsThe authors declare that no experiments have been performed on humans or animals in this research.Confidentiality of dataThe authors declare that they have adhered to the protocols of their centre of work on the publication of patient data.Right to privacy and informed consentThe authors declare that no patient data appear in this article.Conflict of interestThe authors received no financial assistance for this study nor signed any agreements to receive any benefits or fees from any business entity. Furthermore, no business entity has or will pay any foundations, educational institutions or other non-profit organisations with which the authors are affiliated." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres1052806" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1003439" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1052805" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1003440" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Material and methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Surgical technique" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Postoperative evaluation" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:1 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Analysis of results" ] ] ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Conclusions" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Level of evidence" ] 10 => array:3 [ "identificador" => "sec0055" "titulo" => "Ethical disclosures" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0060" "titulo" => "Protection of human and animal subjects" ] 1 => array:2 [ "identificador" => "sec0065" "titulo" => "Confidentiality of data" ] 2 => array:2 [ "identificador" => "sec0070" "titulo" => "Right to privacy and informed consent" ] ] ] 11 => array:2 [ "identificador" => "sec0075" "titulo" => "Conflict of interest" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2017-07-18" "fechaAceptado" => "2018-01-31" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1003439" "palabras" => array:4 [ 0 => "Intraarticular" 1 => "Calcaneal fracture" 2 => "Surgical treatment" 3 => "Osteosynthesis" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1003440" "palabras" => array:4 [ 0 => "Intraarticular" 1 => "Fractura de calcáneo" 2 => "Tratamiento quirúrgico" 3 => "Osteosíntesis" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectiveTo evaluate the results of surgical treatment of intraarticular calcaneal fractures, and also to analyse the variables that influence the final clinical and radiological outcomes as well as the complications. Material and methodsWe retrospectively analysed 86 intraarticular calcaneal fractures in 78 patients, who underwent surgery with an extended lateral approach and reconstruction plate. The mean age was 48 years (16–74 years) and the mean follow-up was 4.6 years (9–99 months); 54 patients (69.2%) suffered falls from less than 3m in height or banal injuries and 24 patients (30.8%) falls from more than 3m in height or high energy-accidents. According to the Sanders classification we operated 12 (15%) type II, 54 (62.8%) type III and 20 (23.2%) type IV fractures. ResultsThe postoperative mean AOFAS score was 73.9 points, with good or excellent results in 57% of the patients. Twelve cases (14%) suffered surgical wound complications and 11 (12.8%) required subtalar arthrodesis. Significantly better results were obtained in the patients younger than 30 years old, patients that fell from less than 3m in height and patients with Sanders fractures types II and III compared to type IV, which were associated with higher rate of subtalar arthrodesis. ConclusionsWe consider that open reduction and internal fixation of intraarticular fractures of the calcaneus with reconstruction plate is a valid treatment alternative. Given the complications described and the secondary subtalar arthrodesis rate, we recommend a meticulous technique carried out by experienced surgeons." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivoEvaluar los resultados del tratamiento quirúrgico de las fracturas intraarticulares de calcáneo. Analizar las variables que influyen en el resultado clínico y radiológico final, así como las complicaciones dadas. Material y métodosAnalizamos de forma retrospectiva 86 fracturas intraarticulares de calcáneo en 78 pacientes, intervenidas en nuestro servicio mediante abordaje lateral extendido y placa de reconstrucción. La edad media fue de 48 años (16-74 años) y el seguimiento medio de 4,6 años (9-99 meses); 54 pacientes (69,2%) sufrieron caídas de menos de 3 m de altura o traumatismos banales, y 24 (30,8%) de más de 3 m o accidentes de alta energía. Según la clasificación de Sanders, intervinimos 12 fracturas (15%) tipo II, 54 (62,8%) tipo III y 20 (23,2%) tipo IV. ResultadosLa puntuación AOFAS media postoperatoria fue de 73,9 puntos (42-98 puntos), con resultados buenos o excelentes en el 57% de los casos; 12 casos (14%) presentaron complicaciones a nivel de la herida quirúrgica y 11 (12,8%) precisaron una artrodesis subastragalina. Obtuvimos resultados significativamente mejores en pacientes menores de 30 años, pacientes con caídas de menos de 3 m de altura y pacientes con fracturas tipos II y III de Sanders respecto a las tipo IV, asociándose a estas una mayor tasa de artrodesis subastragalina. ConclusionesConsideramos la reducción abierta y fijación interna de las fracturas intraarticulares de calcáneo con placa de reconstrucción una alternativa vigente. Dadas las complicaciones descritas y la tasa de artrodesis subastragalina secundaria, recomendamos una técnica meticulosa por parte de cirujanos experimentados." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "Please cite this article as: Diranzo-García J, Bertó-Martí X, Castillo-Ruiperez L, Estrems-Díaz V, Hernández-Ferrando L, Villodre-Jiménez J, et al. Tratamiento de las fracturas intraarticulares de calcáneo mediante placa de reconstrucción. Resultados y complicaciones de 86 fracturas. Rev Esp Cir Ortop Traumatol. 2018;62:267–273." ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 641 "Ancho" => 1400 "Tamanyo" => 159272 ] ] "descripcion" => array:1 [ "en" => "(A) Reduction of the subtalar joint after removal of the lateral wall. (B) Fracture fixation with low profile reconstruction plate." ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 647 "Ancho" => 1800 "Tamanyo" => 88621 ] ] "descripcion" => array:1 [ "en" => "Progression of Sanders type IV fracture to a subtalar arthrodesis following primary osteosynthesis." ] ] 2 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "n: number of patients." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Age</td><td class="td" title="table-entry " align="left" valign="top">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Mean (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Median (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Range (years) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">48 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">47 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">16–74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Gender</td><td class="td" title="table-entry " align="left" valign="top">n \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Total \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (28.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">56 (71.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">78 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Aetiology</td><td class="td" title="table-entry " align="left" valign="top">Banal trauma \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fall <3m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Fall >3m \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Traffic accident \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10 (12.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">44 (56.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">22 (28.2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2 (2.6%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Sanders classification</td><td class="td" title="table-entry " align="left" valign="top">Type I \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Type II \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Type III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Type IV \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0 (0%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">12 (15%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">54 (62.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">20 (23.2%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Associated fractures</td><td class="td" title="table-entry " align="left" valign="top">Rachis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Pelvis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Upper limbs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Lower limbs \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9 (11.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3 (3.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (10.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9 (11.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " rowspan="2" align="left" valign="top">Concomitant pathology</td><td class="td" title="table-entry " align="left" valign="top">Tobacco habit \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Alcohol/drugs \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Psychiatric disorders \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">38 (48.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (16.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8 (10.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">13 (16.7%) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1789261.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Demographic data of all patients." ] ] 3 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "p value: statistical significance." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AOFAS \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Global \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>3m height/high energy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">75.59±11.5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><3m height/banal \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">73.80±9.42 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">p value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.029 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">>30 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">72.07±10.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><30 years old \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">77.06±9.9 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">p value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.037 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sanders II–III \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">79.1±9.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sanders IV \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">67.9±9.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">p value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative Böhler \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">17.1±7.3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative Böhler \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.2±9.1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">p value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.023 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative Gissane \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">83.3±11.4 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative Gissane \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">118.6±12.02 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">p value \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">0.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1789260.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Correlation between functional outcomes and variables with statistically significant relevance." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0160" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fracturas de calcáneo: controversias y consensos" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M. Herrera-Pérez" 1 => "M.J. Gutiérrez-Morales" 2 => "V. Valderrabano" 3 => "M. Wiewiorski" 4 => "J.L. Pais-Brito" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Pie Tobillo" "fecha" => "2016" "volumen" => "30" "paginaInicial" => "1" "paginaFinal" => "12" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0165" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The epidemiology of calcaneal fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M.J. Mitchell" 1 => "J.C. McKinley" 2 => "C.M. Robinson" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Foot (Edinb)" "fecha" => "2009" "volumen" => "19" "paginaInicial" => "197" "paginaFinal" => "200" "itemHostRev" => array:3 [ "pii" => "S2213260017301297" "estado" => "S300" "issn" => "22132600" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0170" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An economic evaluation of operative compared with nonoperative management of displaced intra-articular calcaneal fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.A. Brauer" 1 => "B.J. Manns" 2 => "M. Ko" 3 => "C. Donaldson" 4 => "R. Buckley" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.E.00166" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2005" "volumen" => "87" "paginaInicial" => "2741" "paginaFinal" => "2749" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16322625" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0175" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Age, gender, work capability, and worker's compensation in patients with displaced intraarticular calcaneal fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T.V. Tufescu" 1 => "R. Buckley" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Orthop Trauma" "fecha" => "2001" "volumen" => "15" "paginaInicial" => "275" "paginaFinal" => "279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11371793" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1556086417328666" "estado" => "S300" "issn" => "15560864" ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0180" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manejo actual de las fracturas intraarticulares de calcáneo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. López-Oliva" 1 => "F. Forriol" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cir Ortop Traumatol" "fecha" => "2011" "volumen" => "55" "paginaInicial" => "476" "paginaFinal" => "484" "itemHostRev" => array:3 [ "pii" => "S1556086415318633" "estado" => "S300" "issn" => "15560864" ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0185" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Operative versus nonoperative treatment of displaced intra-articular calcaneal fracture: a prospective, randomized, controlled multicenter trial" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "P.H. Agren" 1 => "P. Wretenberg" 2 => "A.S. Sayed-Noor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.L.00759" "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2013" "volumen" => "95" "paginaInicial" => "1351" "paginaFinal" => "1357" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23925738" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0190" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Operative versus nonoperative treatment for displaced intra-articular calcaneal fractures: a meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "X. Luo" 1 => "Q. Li" 2 => "S. He" 3 => "S. He" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.jfas.2016.01.035" "Revista" => array:6 [ "tituloSerie" => "J Foot Ankle Surg" "fecha" => "2016" "volumen" => "55" "paginaInicial" => "821" "paginaFinal" => "828" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27150233" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0195" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Wound healing complications in closed and open calcaneal fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.K. Benirschke" 1 => "P.A. Kramer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Orthop Trauma" "fecha" => "2004" "volumen" => "18" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14676549" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0200" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "R. Buckley" 1 => "S. Tough" 2 => "R. McCormack" 3 => "G. Pate" 4 => "R. Leighton" 5 => "D. Petrie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2002" "volumen" => "84-A" "paginaInicial" => "1733" "paginaFinal" => "1744" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12377902" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0205" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Operative treatment of displaced intra-articular calcaneal fractures: long-term (10–20 years) results in 108 fractures using a prognostic CT classification" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Sanders" 1 => "Z.M. Vaupel" 2 => "M. Erdogan" 3 => "M. Downes" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/BOT.0000000000000169" "Revista" => array:6 [ "tituloSerie" => "J Orthop Trauma" "fecha" => "2014" "volumen" => "28" "paginaInicial" => "551" "paginaFinal" => "563" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25243849" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0210" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advances in surgical management of intra-articular calcaneus fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A.R. Hsu" 1 => "R.B. Anderson" 2 => "B.E. Cohen" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.5435/JAAOS-D-14-00287" "Revista" => array:6 [ "tituloSerie" => "J Am Acad Orthop Surg" "fecha" => "2015" "volumen" => "23" "paginaInicial" => "399" "paginaFinal" => "407" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26111874" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0215" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Fracturas intraarticulares de calcáneo. Técnica quirúrgica mediante abordaje lateral ampliado" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "A. Dalmau-Coll" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Rev Pie Tobillo" "fecha" => "2012" "volumen" => "26" "paginaInicial" => "50" "paginaFinal" => "58" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0220" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The operative management of displaced intra-articular fractures of the calcaneum: a two-centre study using a defined protocol" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.D. Tennent" 1 => "P.R. Calder" 2 => "R.D. Salisbury" 3 => "P.W. Allen" 4 => "D.M. Eastwood" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2001" "volumen" => "32" "paginaInicial" => "491" "paginaFinal" => "496" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11476816" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0225" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of calcaneal fractures: what have we learnt over the years?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "E. Guerado" 1 => "M.L. Bertrand" 2 => "J.R. Cano" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.injury.2012.05.011" "Revista" => array:6 [ "tituloSerie" => "Injury" "fecha" => "2012" "volumen" => "43" "paginaInicial" => "1640" "paginaFinal" => "1650" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22664393" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0230" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Intra-articular fractures of the calcaneus: present state of the art" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R. Sanders" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Orthop Trauma" "fecha" => "1992" "volumen" => "6" "paginaInicial" => "252" "paginaFinal" => "265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1602349" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0235" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Open reduction and internal fixation of calcaneal fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "E. LeTournel" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:5 [ "titulo" => "Topics in orthopedic surgery" "paginaInicial" => "173" "paginaFinal" => "192" "edicion" => "1st ed." "serieFecha" => "1984" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0240" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Extensive intraarticular fractures of the foot: surgical management of calcaneus fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S.K. Benirschke" 1 => "B. Sangeorzan" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Clin Orthop" "fecha" => "1993" "volumen" => "292" "paginaInicial" => "128" "paginaFinal" => "134" "itemHostRev" => array:3 [ "pii" => "S1470204517302395" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0245" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The mechanism and treatment of fractures of the calcaneus: open reduction with the use of cancellous grafts" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "I. Palmer" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "1948" "volumen" => "30" "paginaInicial" => "2" "paginaFinal" => "8" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0250" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Responsiveness and validity of the SF-36, Ankle Osteoarthritis Scale AOFAS Ankle Hindfoot Score, and Foot Function Index in end stage ankle arthritis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N.J. Madeley" 1 => "K.J. Wing" 2 => "C. Topliss" 3 => "M.J. Penner" 4 => "M.A. Glazebrook" 5 => "A.S. Younger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3113/FAI.2012.0057" "Revista" => array:6 [ "tituloSerie" => "Foot Ankle Int" "fecha" => "2012" "volumen" => "33" "paginaInicial" => "57" "paginaFinal" => "63" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22381237" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0255" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Evaluation of the validity of the AOFAS clinical rating systems by correlation to the SF-36" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "N.F. SooHoo" 1 => "M. Shuler" 2 => "L.L. Fleming" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/107110070302400108" "Revista" => array:6 [ "tituloSerie" => "Foot Ankle Int" "fecha" => "2003" "volumen" => "24" "paginaInicial" => "50" "paginaFinal" => "55" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12540082" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0260" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Secuelas de las fracturas de calcáneo y encuesta nacional" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Noriega" 1 => "J.M. Cáceres" 2 => "J. Vilá" 3 => "E. Iglesias" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Esp Cir Ortop Traumatol" "fecha" => "2005" "volumen" => "49" "numero" => "Suppl. 1" "paginaInicial" => "78" "paginaFinal" => "89" ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0265" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subtalar fusion after displaced intra-articular calcaneal fractures: does initial operative treatment matter?" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C.S. Radnay" 1 => "M.P. Clare" 2 => "R.W. Sanders" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.2106/JBJS.G.01445" "Revista" => array:7 [ "tituloSerie" => "J Bone Joint Surg Am" "fecha" => "2009" "volumen" => "91" "paginaInicial" => "541" "paginaFinal" => "546" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19255213" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0169500217304014" "estado" => "S300" "issn" => "01695002" ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0270" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of calcaneal malunion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R. Banerjee" 1 => "C. Saltzman" 2 => "R.B. Anderson" 3 => "F. Nickisch" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Am Acad Orthop Surg" "fecha" => "2011" "volumen" => "19" "paginaInicial" => "27" "paginaFinal" => "36" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21205765" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0275" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.L. Howard" 1 => "R. Buckley" 2 => "R. McCormack" 3 => "G. Pate" 4 => "R. Leighton" 5 => "D. Petrie" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Orthop Trauma" "fecha" => "2003" "volumen" => "17" "paginaInicial" => "241" "paginaFinal" => "249" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12679683" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204517304461" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0280" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Displaced intra-articular calcaneal fractures: variables predicting late subtalar fusion" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Csziy" 1 => "R. Buckley" 2 => "S. Tough" 3 => "R. Leighton" 4 => "J. Smith" 5 => "R. McCormack" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Orthop Trauma" "fecha" => "2003" "volumen" => "17" "paginaInicial" => "106" "paginaFinal" => "112" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12571499" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204516305654" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0285" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Chondrocyte viability after intra-articular calcaneal fractures in humans" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.T. Ball" 1 => "K. Jardin" 2 => "R.T. Allen" 3 => "A.K. Schwartz" 4 => "R.L. Sah" 5 => "M.E. Brage" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3113/FAI.2007.0665" "Revista" => array:6 [ "tituloSerie" => "Foot Ankle Int" "fecha" => "2007" "volumen" => "28" "paginaInicial" => "665" "paginaFinal" => "668" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17592695" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0290" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary subtalar arthrodesis for the treatment of comminuted calcaneal fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "B.D. Buch" 1 => "M.S. Myerson" 2 => "S.D. Miller" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1177/107110079601700202" "Revista" => array:6 [ "tituloSerie" => "Foot Ankle Int" "fecha" => "1996" "volumen" => "17" "paginaInicial" => "61" "paginaFinal" => "70" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8919403" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0295" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The primary arthrodesis for severely comminuted intra-articular fractures of the calcaneus: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "T. Schepers" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Foot Ankle Surg" "fecha" => "2012" "volumen" => "18" "paginaInicial" => "84" "paginaFinal" => "88" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0300" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Operative versus non-operative treatment for closed, displaced, intra-articular fractures of the calcaneus: randomised controlled trial" "autores" => array:1 [ 0 => array:3 [ "colaboracion" => "UK Heel Fracture Trial Investigators" "etal" => true "autores" => array:6 [ 0 => "D. Griffin" 1 => "N. Parsons" 2 => "E. Shaw" 3 => "Y. Kulikov" 4 => "C. Hutchinson" 5 => "M. Thorogood" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "BMJ" "fecha" => "2014" "volumen" => "349" "paginaInicial" => "g4483" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25059747" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0305" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.W. Folk" 1 => "A.J. Starr" 2 => "J.S. Early" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "J Orthop Trauma" "fecha" => "1999" "volumen" => "13" "paginaInicial" => "369" "paginaFinal" => "372" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10406705" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S1470204516306246" "estado" => "S300" "issn" => "14702045" ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0310" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Radiographic and functional outcomes after displaced intra-articular calcaneal fractures: a comparative cohort study among the traditional open technique (ORIF) and percutaneous surgical procedures (PS)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "C. Biz" 1 => "E. Barison" 2 => "P. Ruggieri" 3 => "C. Iacobellis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/s13018-016-0426-6" "Revista" => array:5 [ "tituloSerie" => "J Orthop Surg Res" "fecha" => "2016" "volumen" => "11" "paginaInicial" => "92" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27550340" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/19888856/0000006200000004/v1_201807060854/S1988885618300373/v1_201807060854/en/main.assets" "Apartado" => array:4 [ "identificador" => "7577" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original articles" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/19888856/0000006200000004/v1_201807060854/S1988885618300373/v1_201807060854/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300373?idApp=UINPBA00004N"]

Statistics

Original Article

Treatment of intraarticular calcaneal fractures by reconstruction plate. Results and complications of 86 fractures

Tratamiento de las fracturas intraarticulares de calcáneo mediante placa de reconstrucción. Resultados y complicaciones de 86 fracturas

J. Diranzo-García

Corresponding author

pdiranzo@gmail.com

Corresponding author.

, X. Bertó-Martí, L. Castillo-Ruiperez, V. Estrems-Díaz, L. Hernández-Ferrando, J. Villodre-Jiménez, A. Bru-Pomer

Servicio de Cirugía Ortopédica y Traumatología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain

Read

2873

Times
was read the article

468

Total PDF

2405

Total HTML

Share statistics

 array:24 [
  "pii" => "S1988885618300373"
  "issn" => "19888856"
  "doi" => "10.1016/j.recote.2018.04.007"
  "estado" => "S300"
  "fechaPublicacion" => "2018-07-01"
  "aid" => "734"
  "copyright" => "SECOT"
  "copyrightAnyo" => "2018"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Rev Esp Cir Ortop Traumatol. 2018;62:267-73"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "es" => array:19 [
      "pii" => "S188844151830016X"
      "issn" => "18884415"
      "doi" => "10.1016/j.recot.2018.01.010"
      "estado" => "S300"
      "fechaPublicacion" => "2018-07-01"
      "aid" => "734"
      "copyright" => "SECOT"
      "documento" => "article"
      "crossmark" => 1
      "subdocumento" => "fla"
      "cita" => "Rev Esp Cir Ortop Traumatol. 2018;62:267-73"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:2 [
        "total" => 184
        "formatos" => array:2 [
          "HTML" => 128
          "PDF" => 56
        ]
      ]
      "es" => array:13 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Original</span>"
        "titulo" => "Tratamiento de las fracturas intraarticulares de calc&#225;neo mediante placa de reconstrucci&#243;n&#46; Resultados y complicaciones de 86 fracturas"
        "tienePdf" => "es"
        "tieneTextoCompleto" => "es"
        "tieneResumen" => array:2 [
          0 => "es"
          1 => "en"
        ]
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "267"
            "paginaFinal" => "273"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "en" => array:1 [
            "titulo" => "Treatment of intraarticular calcaneal fractures by reconstruction plate&#46; Results and complications of 86 fractures"
          ]
        ]
        "contieneResumen" => array:2 [
          "es" => true
          "en" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "es" => true
        ]
        "contienePdf" => array:1 [
          "es" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0010"
            "etiqueta" => "Figura 2"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr2.jpeg"
                "Alto" => 647
                "Ancho" => 1800
                "Tamanyo" => 88393
              ]
            ]
            "descripcion" => array:1 [
              "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Progresi&#243;n de una fractura tipo<span class="elsevierStyleHsp" style=""></span>IV de Sanders a una artrodesis subastragalina tras osteos&#237;ntesis primaria&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "J&#46; Diranzo-Garc&#237;a, X&#46; Bert&#243;-Mart&#237;, L&#46; Castillo-Ruiperez, V&#46; Estrems-D&#237;az, L&#46; Hern&#225;ndez-Ferrando, J&#46; Villodre-Jim&#233;nez, A&#46; Bru-Pomer"
            "autores" => array:7 [
              0 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Diranzo-Garc&#237;a"
              ]
              1 => array:2 [
                "nombre" => "X&#46;"
                "apellidos" => "Bert&#243;-Mart&#237;"
              ]
              2 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Castillo-Ruiperez"
              ]
              3 => array:2 [
                "nombre" => "V&#46;"
                "apellidos" => "Estrems-D&#237;az"
              ]
              4 => array:2 [
                "nombre" => "L&#46;"
                "apellidos" => "Hern&#225;ndez-Ferrando"
              ]
              5 => array:2 [
                "nombre" => "J&#46;"
                "apellidos" => "Villodre-Jim&#233;nez"
              ]
              6 => array:2 [
                "nombre" => "A&#46;"
                "apellidos" => "Bru-Pomer"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "es"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S1988885618300373"
          "doi" => "10.1016/j.recote.2018.04.007"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300373?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S188844151830016X?idApp=UINPBA00004N"
      "url" => "/18884415/0000006200000004/v1_201807050410/S188844151830016X/v1_201807050410/es/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S1988885618300361"
    "issn" => "19888856"
    "doi" => "10.1016/j.recote.2018.04.006"
    "estado" => "S300"
    "fechaPublicacion" => "2018-07-01"
    "aid" => "729"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2018;62:274-81"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 4
      "formatos" => array:2 [
        "HTML" => 2
        "PDF" => 2
      ]
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Are Modic changes in patients with chronic low back pain indicative of a worse clinical course&#63; 10 years of follow-up"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "274"
          "paginaFinal" => "281"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "&#191;Supone la presencia de cambios Modic en pacientes con dolor lumbar cr&#243;nico una peor evoluci&#243;n cl&#237;nica y una mayor posibilidad de precisar cirug&#237;a&#63; Evoluci&#243;n a 10 a&#241;os"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Figure 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 1323
              "Ancho" => 2519
              "Tamanyo" => 129753
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Graphical representation using boxplot of lumbar VAS and in the leg in patients with&#47;without type changes&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "L&#46;M&#46; Romero-Mu&#241;oz, A&#46; Barriga-Mart&#237;n, A&#46; Segura-Fragoso, C&#46; Mart&#237;n-Gonz&#225;lez"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "L&#46;M&#46;"
              "apellidos" => "Romero-Mu&#241;oz"
            ]
            1 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Barriga-Mart&#237;n"
            ]
            2 => array:2 [
              "nombre" => "A&#46;"
              "apellidos" => "Segura-Fragoso"
            ]
            3 => array:2 [
              "nombre" => "C&#46;"
              "apellidos" => "Mart&#237;n-Gonz&#225;lez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1888441518300110"
        "doi" => "10.1016/j.recot.2018.01.005"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441518300110?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300361?idApp=UINPBA00004N"
    "url" => "/19888856/0000006200000004/v1_201807060854/S1988885618300361/v1_201807060854/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S1988885618300385"
    "issn" => "19888856"
    "doi" => "10.1016/j.recote.2018.04.008"
    "estado" => "S300"
    "fechaPublicacion" => "2018-07-01"
    "aid" => "735"
    "copyright" => "SECOT"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Rev Esp Cir Ortop Traumatol. 2018;62:257-66"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Technical aspects and complications in the surgical treatment of poliomyelitis-affected lower limb fractures"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "257"
          "paginaFinal" => "266"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Aspectos t&#233;cnicos y complicaciones en el tratamiento de las fracturas de los miembros inferiores con secuelas de poliomielitis"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1510
              "Ancho" => 2333
              "Tamanyo" => 369892
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Neck of the femur fracture treated with total hip replacement with intraoperative instability &#40;A&#8211;C&#41;&#46; Periprosthetic fracture treated with plate &#40;D&#8211;H&#41;&#46; Intraoperative iatrogenic fracture &#40;E&#44; arrow&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Mingo-Robinet, J&#46;A&#46; Alonso, M&#46; Moreno-Barrero, L&#46; Gonz&#225;lez-Garc&#237;a, V&#46; Garcia-Virto, H&#46;J&#46; Aguado"
          "autores" => array:6 [
            0 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "Mingo-Robinet"
            ]
            1 => array:2 [
              "nombre" => "J&#46;A&#46;"
              "apellidos" => "Alonso"
            ]
            2 => array:2 [
              "nombre" => "M&#46;"
              "apellidos" => "Moreno-Barrero"
            ]
            3 => array:2 [
              "nombre" => "L&#46;"
              "apellidos" => "Gonz&#225;lez-Garc&#237;a"
            ]
            4 => array:2 [
              "nombre" => "V&#46;"
              "apellidos" => "Garcia-Virto"
            ]
            5 => array:2 [
              "nombre" => "H&#46;J&#46;"
              "apellidos" => "Aguado"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "es" => array:9 [
        "pii" => "S1888441518300171"
        "doi" => "10.1016/j.recot.2018.01.011"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "es"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1888441518300171?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300385?idApp=UINPBA00004N"
    "url" => "/19888856/0000006200000004/v1_201807060854/S1988885618300385/v1_201807060854/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Treatment of intraarticular calcaneal fractures by reconstruction plate&#46; Results and complications of 86 fractures"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "267"
        "paginaFinal" => "273"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "J&#46; Diranzo-Garc&#237;a, X&#46; Bert&#243;-Mart&#237;, L&#46; Castillo-Ruiperez, V&#46; Estrems-D&#237;az, L&#46; Hern&#225;ndez-Ferrando, J&#46; Villodre-Jim&#233;nez, A&#46; Bru-Pomer"
        "autores" => array:7 [
          0 => array:4 [
            "nombre" => "J&#46;"
            "apellidos" => "Diranzo-Garc&#237;a"
            "email" => array:1 [
              0 => "pdiranzo&#64;gmail&#46;com"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "X&#46;"
            "apellidos" => "Bert&#243;-Mart&#237;"
          ]
          2 => array:2 [
            "nombre" => "L&#46;"
            "apellidos" => "Castillo-Ruiperez"
          ]
          3 => array:2 [
            "nombre" => "V&#46;"
            "apellidos" => "Estrems-D&#237;az"
          ]
          4 => array:2 [
            "nombre" => "L&#46;"
            "apellidos" => "Hern&#225;ndez-Ferrando"
          ]
          5 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Villodre-Jim&#233;nez"
          ]
          6 => array:2 [
            "nombre" => "A&#46;"
            "apellidos" => "Bru-Pomer"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:2 [
            "entidad" => "Servicio de Cirug&#237;a Ortop&#233;dica y Traumatolog&#237;a&#44; Consorcio Hospital General Universitario de Valencia&#44; Valencia&#44; Spain"
            "identificador" => "aff0005"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Tratamiento de las fracturas intraarticulares de calc&#225;neo mediante placa de reconstrucci&#243;n&#46; Resultados y complicaciones de 86 fracturas"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 647
            "Ancho" => 1800
            "Tamanyo" => 88621
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Progression of Sanders type IV fracture to a subtalar arthrodesis following primary osteosynthesis&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The bone most commonly injured in the tarsus is the calcaneus&#44; accounting for between 1&#37; and 2&#37; of all fractures&#46; Approximately 75&#37; will be intraarticular&#44; with 10&#37; associated with fracture at rachis level and 26&#37; other fractures at lower limb level&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The great majority of these fractures occur in young people in a working environment&#44; frequently due to haste or high energy accidents&#44; leading to long sick leave and major socio-economic impact&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Intraarticular calcaneal fractures are characterised by current controversy regarding their treatment&#44; since many different solutions and opinions may be encountered for the same fracture&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">5</span></a> However&#44; although authors in the literature agree that available evidence is insufficient to state that surgical treatment is superior to conservative treatment&#44;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;7</span></a> the current trend is for open reduction and internal fixation&#46;<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">8&#8211;10</span></a> Due to orthopaedic surgeons&#8217; fear of the complications described for surgical wounds using the &#8220;extended L shaped lateral approach&#8221; considered the gold standard surgery&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">1</span></a> minimally invasive techniques are now increasing&#46; Described outcomes are favourable although technically these techniques are more demanding and require a greater learning curve&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">11</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The objectives of surgical treatment are to restore the three-dimensional anatomy of the calcaneus &#40;in height&#44; length and width&#41; and the anatomical reduction of the joint surfaces&#46; Finally&#44; functional restoration is sought as soon as possible&#44; with a stable osteosynthesis&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;12&#8211;14</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore&#44; given the gravity and complexity of this type of injury&#44; associated with the rate of surgical complications and physical sequelae it may entail&#44; calcaneal fractures continue to be a genuine challenge for the orthopaedic surgeon&#46; The aim of our study is to assess the result of surgical treatment of intraarticular calcaneal fractures&#44; and to analyse the variables which have an influence on obtaining these results&#46; We therefore conducted an retrospective observational study in patients who had undergone surgery for intraarticular calcaneal fractures&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Between August 2006 and March 2016 a total of 97 consecutive calcaneal fractures were performed in 88 patients &#40;9 bilateral fractures&#41; using an extended lateral &#8220;L-shaped&#8221; approach and a low profile reconstruction plate&#46; We excluded from the study all patients with fractures which were considered conservative and we included all patients who underwent surgery using the said technique&#46; Ten patients were lost to follow-up&#58; 2 &#40;2&#46;3&#37;&#41; died from non-surgical causes&#59; 3 &#40;3&#46;4&#37;&#41; were patients who were inmates in a prison&#44; who were transferred to centres outside of our healthcare area&#44; and we were unable to locate 5 patients &#40;5&#46;7&#37;&#41;&#46; The final sample included 78 patients and 86 intraarticular calcaneal fractures &#40;8 patients with bilateral surgery&#41; whose clinical and radiologic follow-up has been retrospectively analysed&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Out of the 78 patients&#44; 56 &#40;71&#46;8&#37;&#41; were male and 22 &#40;28&#46;2&#37;&#41; female&#46; Mean age at surgery was 48<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;24 years&#46; A total of 53 patients &#40;67&#46;9&#37;&#41; presented with associated comorbidity&#58; 38 patients &#40;48&#46;7&#37;&#41; with a tobacco habit&#59; 20 &#40;25&#46;6&#37;&#41; with a history of psychiatric disorders&#59; 13 &#40;16&#46;7&#37;&#41; with drug or alcohol abuse&#59; 13 &#40;16&#46;7&#37;&#41; with chronic use of corticosteroids&#59; 8 &#40;10&#46;3&#37;&#41; with diabetes mellitus and 8 &#40;10&#46;3&#37;&#41; with infectious-contagious diseases &#40;HIV or hepatitis B or C&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">With regard to the production mechanism&#44; 44 &#40;56&#46;4&#37;&#41; of patients suffered from falls of under 3<span class="elsevierStyleHsp" style=""></span>m height and 22 &#40;28&#46;2&#37;&#41; of over 3<span class="elsevierStyleHsp" style=""></span>m&#46; Ten patients &#40;12&#46;8&#37;&#41; presented with fractures after ankle sprain or banal trauma and 2 patients &#40;2&#46;6&#37;&#41; after high energy traffic accidents&#46; Nineteen patients &#40;24&#46;4&#37;&#41; presented with associated fractures&#58; 9 &#40;11&#46;5&#37;&#41; with fractures at rachis level&#59; 9 &#40;11&#46;5&#37;&#41; with fractures in lower limbs&#59; 8 &#40;10&#46;3&#37;&#41; in upper limbs and 3 &#40;3&#46;8&#37;&#41; at pelvic level&#46; Seventeen patients &#40;21&#46;8&#37;&#41; had fractures of both heel bones&#44; and 8 of them underwent bilateral surgery&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">All the fractures were classified in accordance with Sanders<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">15</span></a> classification&#44; based on computerised tomography imaging &#40;CAT&#41;&#44; resulting in 12 &#40;15&#37;&#41; type II fractures&#44; 54 &#40;62&#46;8&#37;&#41; type III and 20 &#40;23&#46;2&#37;&#41; type IV &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; We measured the B&#246;hler and Gissane angles on the lateral radiographies&#44; obtaining a preoperative mean B&#246;hler angle of 17&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;29&#176; and a preoperative mean Gissane angle of 83&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;4&#176;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Surgical technique</span><p id="par0050" class="elsevierStylePara elsevierViewall">All cases were operated on by the same surgical team&#46; 80&#46;2&#37; of patients were operated on during the first 15 days after the fracture &#40;range between 4 and 22 days&#41;&#44; provided that the state of the soft tissues was optimal and the wrinkle test positive&#46; Mean time in surgery was 132<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>33<span class="elsevierStyleHsp" style=""></span>min&#46; Surgery was performed with the patient in lateral decubitus position&#44; lower extremity ischaemia positioned at thigh level and with intraoperative fluoroscopy control &#40;profile&#44; axial and Broden projections&#41;&#46; In order to do this&#44; in all cases&#44; we used the &#8220;extended lateral L shaped approach&#8221; proposed by Palmer and Letournel and later modified by Benirschke&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">16&#8211;18</span></a> We made a complete flap protecting the sural nerve and the peroneal tendons&#46; The fracture was reduced after removal of the side wall &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#44; beginning with the anterior tuberosity and continuing through the anteromedial articular facets and subtalar joint&#44; finishing in the posterior tuberosity&#44; with provisional attachment using Kirschner needles and with accurate three-dimensional reconstruction of the calcaneus and articular surfaces confirmed by fluoroscopy&#46; After this&#44; after repositioning the side wall in its anatomic location&#44; fixation was performed low profile plates in all cases with non-blocking nails &#40;Synthes Locking Calcaneal Plate<span class="elsevierStyleSup">&#174;</span>&#44; Synthes USA&#44; Paoli&#44; USA&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; We inserted a Redon type aspiration drainage system in all patients&#44; which was removed after 48<span class="elsevierStyleHsp" style=""></span>h if it had not been productive&#46; Partial weight bearing was not permitted until the sixth week and complete weight bearing until the 12th week&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Postoperative evaluation</span><p id="par0055" class="elsevierStylePara elsevierViewall">All patients were assessed at 4 weeks&#44; 8 weeks&#44; 3 months&#44; 6 months and subsequently annually for clinical examination and radiographic follow-up&#46; Standard evaluation in each visit included the American Orthopaedic Foot and Ankle Society Score &#40;AOFAS&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0250"><span class="elsevierStyleSup">19&#44;20</span></a> taking the score obtained in the last patient check-up in the last consultation considered as the final follow-up&#46; We then analysed the relationship between the score from the AOFAS and each of the different variables&#58; gender&#44; age&#44; presence of comorbidity &#40;tobacco habit&#44; drug or alcohol abuse&#44; a history of psychiatric disorders&#44; diabetes&#44; chronic intake of corticosteroids or infectious and contagious diseases&#41;&#44; bilaterality or unilaterality of concomitant fractures&#44; lesional mechanism and classification of fracture according to Sanders&#46; We finally compared the post-surgical radiologic results in the last check up to the preoperative studies by measuring the B&#246;hler and Gissane angles&#44; and we analysed their relationship to final functional results&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0060" class="elsevierStylePara elsevierViewall">Data analysis was performed using the SPSS 22 statistical programme for MAC OS &#40;version 22&#59; SPSS&#44; Chicago&#44; IL&#44; USA&#41;&#46; We made a descriptive analysis&#44; expressing the qualitative variables such as absolute and relative frequencies and the quantitative variables such as the mean and standard deviation &#40;SD&#41;&#46; We conducted a bivariate study&#44; using the parametric Fisher Student&#39;s <span class="elsevierStyleItalic">t</span>-test for the quantitative variables and the non-parametric Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test for normality of distribution&#44; the parametric Chi-squared test for the qualitative variables and the exact Fisher test for the non-parametric test&#46; The significance level was established at 5&#37;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall">Mean follow-up time of the 86 cases &#40;78 patients&#41; was 55<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>25 months&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Clinical and radiologic results</span>&#46; The mean AOFAS score obtained was 73&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;2 points out of 100 &#40;95&#37; CI&#58; 74&#46;49&#8211;78&#46;95 points&#41;&#44; with excellent results &#40;90&#8211;100 points&#41; in 8 cases &#40;9&#46;3&#37;&#41;&#44; good &#40;75&#8211;89 points&#41; in 40 &#40;47&#46;7&#37;&#41;&#44; acceptable &#40;50&#8211;74 points&#41; in 35 &#40;39&#46;5&#37;&#41; and poor &#40;0&#8211;49 points&#41; inn 3 cases &#40;3&#46;5&#37;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The mean postoperative B&#246;hler angle was 27&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&#176;&#44; and Gissane angle was 118&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;02&#176;&#46; We achieved a restoration of the B&#246;hler angle &#40;between 20&#176; and 40&#176;&#41; in 60 patients &#40;69&#46;8&#37;&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">All patients had presented with a complete fracture consolidation at the 6 month check up after surgery&#46; 36 cases &#40;42&#37;&#41; had developed subtalar joint arthrosis which were all found using CAT&#46; In 11 &#40;12&#46;8&#37;&#41;&#44; it was necessary to perform subtalar arthrodesis&#44; which was in one of the 12 cases made with Sanders type II fractures &#40;8&#37;&#41;&#44; in 5 of the 54 cases with Sanders type III fractures &#40;9&#37;&#41;&#44; and in 5 of the 20 cases with Sanders type IV fractures &#40;25&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Complications</span>&#46; Thirteen patients &#40;20&#46;5&#37;&#41; presented with a total of 16 complications&#59; 12 cases &#40;14&#37;&#41; of complications at surgical wound level&#44; 5 &#40;5&#46;8&#37;&#41; cases of superficial infection&#44; treated with surgical cleaning and extraction of osteosynthesis material in 4 cases&#59; 3 patients &#40;3&#46;4&#37;&#41; developed a deep infection or osteomyelitis&#44; all of which were treated with aggressive debridement&#44; extraction of the osteosynthesis material and filling of the defect with antibiotic bone cement&#46; In 2 of these 3 patients&#44; two-stage arthrodesis was performed&#46; In 4 cases &#40;4&#46;7&#37;&#41; a defect in the wound closure occurred without the infection being diagnosed&#44; with treatment being carried out in collaboration with the Ulcer Unit through the application of vacuum therapy&#46; However&#44; in one subject it was necessary to remove the osteosynthesis material and to make a flap closure using plastic surgery&#46; Two patients &#40;2&#46;3&#37;&#41; presented with a neuropathy of the sural nerve&#59; there was one case &#40;1&#46;2&#37;&#41; of Sudeck algodystrophy and one case &#40;1&#46;2&#37;&#41; of calcification at peroneal tendon level treated with surgical tenolysis&#46;</p><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Analysis of results</span><p id="par0090" class="elsevierStylePara elsevierViewall">Statistical analysis did not reveal any statistically significant differences &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; in the functional results obtained in the AOFAS test with respect to gender&#44; patients with unilateral fractures versus bilateral&#44; patients with other concomitant fractures or the cohort of patients under 60 compared with those over 60&#46; Neither did we find any significant association between the patients who presented with an associated comorbidity with functional results &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41; or the appearance of complications during follow-up &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; However&#44; we did obtain significantly better results in patients with falls under 3<span class="elsevierStyleHsp" style=""></span>m height compared with patients with falls of over 3<span class="elsevierStyleHsp" style=""></span>m height or high energy accidents &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;029&#41;&#59; the cohort of patients under 30 &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;037&#41;&#44; and patients with Sanders type II and II fractures compared with Sanders type IV fractures &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41;&#46; In contrast&#44; we did not find results were better if we compared the patients with Sanders type II fractures to those with type III fractures &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;963&#41;&#46; The mean difference of the B&#246;hler and Gissane angles was 10&#46;1&#176; &#40;95&#37; CI&#58; 4&#46;3&#8211;12&#46;1&#176;&#41; and of 35&#46;3&#176; &#40;95&#37; CI&#58; 29&#46;4&#8211;39&#46;1&#176;&#41; respectively&#44; with this improvement being significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;023 and <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#41;&#46; We did not find any better functional results in the cohort of patients where a reduction in the B&#246;hler angle was obtained &#40;20&#8211;40&#176;&#41; &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Discussion</span><p id="par0095" class="elsevierStylePara elsevierViewall">At present there is a tendency among orthopaedic surgeons use surgical treatment for intraarticular calcaneal fractures and specifically open reduction and fixation with a plate with &#8220;extended lateral L-shaped approach&#8221;&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;6&#44;8&#8211;10</span></a> Despite this&#44; evidence is insufficient in the literature to support better surgical treatment outcome as opposed to conservative treatment&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;7</span></a> In our environment&#44; intraarticular calcaneal fractures are of the few intraarticular fractures which have usually been treated conservatively in a high percentage of cases&#44; specifically 57&#46;98&#37;&#46; This result was obtained through a survey carried out in 29 Spanish hospitals and with a total of 624 fractures&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a> This was due to technical complexity and especially to the fear of developing any of the described complications&#44; and in particular those relating to surgical wounds&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">21</span></a> The progression of a subtalar arthrosis was therefore unavoidable due to the unacceptable residual articular congruence&#44; accompanied on many occasions by a non-union with three-dimensional anatomical change of the hindfoot&#46;<a class="elsevierStyleCrossRefs" href="#bib0205"><span class="elsevierStyleSup">10&#44;21&#8211;23</span></a> In their recent meta analysis Luo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">7</span></a> concluded that surgical treatment is not superior to conservative treatment but&#44; despite the lower rate of complications in non-surgical treatment&#44; the risk of subtalar arthrodesis is much higher&#46; In a prospective&#44; randomised controlled study Buckley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> compared the outcome of surgical treatment to conservative treatment&#44; obtaining better clinical results in those patients where anatomical reduction had been achieved&#44; and particularly in those who did not present with occupational disputes&#46; The patients who were conservatively managed were 5&#46;5 times more likely to be operated on again with subtalar arthrodesis&#46; Similarly&#44; Howard et al&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">24</span></a> demonstrated that the patients who had been treated conservatively had five times more risk of subtalar arthrodesis compared to those who underwent surgery&#46; In their study Brauer et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">3</span></a> demonstrated a more favourable outcome in cost-effective analysis for surgical treatment&#46; For their part&#44; Radnay et al&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a> concluded that arthrodesis was highly complicated in cases which had initially been treated conservatively&#44; demonstrating better outcome and a lower rate of complications in patients who had been treated surgically from the beginning&#44; provided that anatomical parameters had been correctly restored&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In our series&#44; on subdividing the sample according to the type of fracture&#44; we observed that the patients with Sanders type IV fractures presented with poorer clinical outcome than those with types II and III&#44; with scores on the postoperative AOFAS scale of 67&#46;9 points for type IV and 79&#46;5 and 78&#46;1 points for type II and III&#44; respectively&#46; A quarter of cases with Sanders type IV fractures required subtalar arthrodesis compared with 8&#37; and 9&#37; of types II and III&#44; respectively&#44; thereby tripling the risk of arthrodesis&#46; Csziy et al&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">25</span></a> concluded in their study that Sanders type IV fractures had 5&#46;5 times more possibilities of developing subtalar arthrosis&#46; The worst prognosis of Sanders type IV fractures&#44; and of the patients who presented with high energy trauma was due firstly to higher complexity in achieving anatomical reduction of the joint and secondly to the poor viability of the joint cartilage after the initial high energy impact&#44;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">1&#44;12&#44;22&#44;26</span></a> responsible for the post-traumatic joint degeneration&#44; which was irreversible in the medium and long term&#44; regardless of the reduction obtained&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">There is currently no consensus regarding the treatment of Sanders type IV fractures&#46; Several authors recommend primary subtalar arthrodesis&#44;<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">15&#44;27</span></a> whilst others advocate primary osteosynthesis as having acceptable outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">22</span></a> Schepers<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">28</span></a> published a systematic review of results after primary arthrodesis with excellent outcomes&#46; However&#44; Buckley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> compared the results obtained after primary osteosynthesis to those of primary arthrodesis and found no major improvement in favour of either technique&#46; In contrast&#44; primary arthrodesis is recommended in patients who seek faster functional recovery in their occupational environment and to avoid possible two-stage surgery&#44; with the financial benefit this entails&#46; In our centre&#44; given the results obtained in Sanders type IV fractures&#44; we decided to initially perform osteosynthesis since 3 out of every 4 patients who underwent surgery did not require subtalar arthodesis&#46; Furthermore&#44; we consider it is more technically complex to carry out primary arthodesis as final treatment&#44; because the need to anatomically reconstruct the calcaneus with stable assemblage in addition to the use of necessary bone grafting to achieve arthrodesis&#44; thus increasing time in surgery and potential complications&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The main problem associated with the &#8220;extended L-shaped lateral approach&#8221; are surgical wound level complications and the rates of these vary between 19&#37; and 23&#37; in the 3 most widely published series&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">6&#44;9&#44;29</span></a> In their series Buckley et al&#46;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">9</span></a> present 17&#37; superficial and 5&#37; deep surgical wound complications&#46; Griffin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">29</span></a> reported problems on the surgical wound level in 19&#37; of cases&#46; For their part&#44; Agren et al&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">6</span></a> presented superficial wound complications in 19&#37; of cases and deep infections in 4&#37; of cases&#46; We had similar results in our series&#44; treating these patients with the Ulcer Unit with vacuum therapy and performing primary surgery with as least trauma possible to the soft tissues&#44; provided that the status of the soft tissues was optimum&#46; In contrast with other authors&#44;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">24&#44;30</span></a> we found no direct relationship between comorbidities and functional outcome&#44; nor with the appearance of complications&#44; although it is true that the control exerted for this type of patient is much narrower&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">With regards to the limitations of our study&#44; our case series was analysed descriptively and retrospectively&#44; and is thus prone to the limitations this type of study&#46; The follow-up period is relatively short and heterogeneous among the different patients&#44; which does not allow for long-term evolution&#46; In our study we did not control the interaction and confusion variables&#44; and the differences found in the results could be due to the causes other than surgical treatment&#46; Moreover&#44; we did not make a comparative study with another surgical technique nor identify the intraarticular calcaneal fractures conservatively during this period&#46; One of the advantages of our study is that the number of cases and their heterogeneity is representative for a unit dealing with this type of trauma on a regular basis&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Conclusions</span><p id="par0120" class="elsevierStylePara elsevierViewall">From the results obtained in our series&#44; we may conclude that open reduction and internal fixation of intraarticular calcaneal fractures using the &#8220;extended L-shaped lateral approach&#8221; is a valid alternative&#46; An accurate surgical technique and optimum care of soft tissues is vital due to the frequent surgical wound complications&#46; From the results obtained&#44; we believe that primary osteosynthesis in patients with Sanders IV type fractures is a valid option&#44; although it must be performed by surgeons who are experienced in this technique&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">We believe the Sanders classification is an important prognostic factor&#44; as is the lesional mechanism and age of the patients&#46; Poorer functional outcome presents in patients with Sanders type IV fractures&#44; with high energy traumas and the cohort of patients over 30 years of age compared with those under 30&#46; Similarly to Biz et al&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">31</span></a> we found no correlation between the anatomical reduction of the B&#246;hler angle and functional results&#46; For this reason&#44; we believe that this angle has no predictive value as a measurement for outcome following surgery&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Level of evidence</span><p id="par0130" class="elsevierStylePara elsevierViewall">Level of evidence IV&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Ethical disclosures</span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Protection of human and animal subjects</span><p id="par0135" class="elsevierStylePara elsevierViewall">The authors declare that no experiments have been performed on humans or animals in this research&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Confidentiality of data</span><p id="par0140" class="elsevierStylePara elsevierViewall">The authors declare that they have adhered to the protocols of their centre of work on the publication of patient data&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Right to privacy and informed consent</span><p id="par0145" class="elsevierStylePara elsevierViewall">The authors declare that no patient data appear in this article&#46;</p></span></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors received no financial assistance for this study nor signed any agreements to receive any benefits or fees from any business entity&#46; Furthermore&#44; no business entity has or will pay any foundations&#44; educational institutions or other non-profit organisations with which the authors are affiliated&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres1052806"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Objective"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Material and methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1003439"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres1052805"
          "titulo" => "Resumen"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Objetivo"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Material y m&#233;todos"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "Resultados"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1003440"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Material and methods"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Surgical technique"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Postoperative evaluation"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0030"
          "titulo" => "Results"
          "secciones" => array:1 [
            0 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Analysis of results"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0045"
          "titulo" => "Conclusions"
        ]
        9 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Level of evidence"
        ]
        10 => array:3 [
          "identificador" => "sec0055"
          "titulo" => "Ethical disclosures"
          "secciones" => array:3 [
            0 => array:2 [
              "identificador" => "sec0060"
              "titulo" => "Protection of human and animal subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0065"
              "titulo" => "Confidentiality of data"
            ]
            2 => array:2 [
              "identificador" => "sec0070"
              "titulo" => "Right to privacy and informed consent"
            ]
          ]
        ]
        11 => array:2 [
          "identificador" => "sec0075"
          "titulo" => "Conflict of interest"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-07-18"
    "fechaAceptado" => "2018-01-31"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1003439"
          "palabras" => array:4 [
            0 => "Intraarticular"
            1 => "Calcaneal fracture"
            2 => "Surgical treatment"
            3 => "Osteosynthesis"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1003440"
          "palabras" => array:4 [
            0 => "Intraarticular"
            1 => "Fractura de calc&#225;neo"
            2 => "Tratamiento quir&#250;rgico"
            3 => "Osteos&#237;ntesis"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">To evaluate the results of surgical treatment of intraarticular calcaneal fractures&#44; and also to analyse the variables that influence the final clinical and radiological outcomes as well as the complications&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">We retrospectively analysed 86 intraarticular calcaneal fractures in 78 patients&#44; who underwent surgery with an extended lateral approach and reconstruction plate&#46; The mean age was 48 years &#40;16&#8211;74 years&#41; and the mean follow-up was 4&#46;6 years &#40;9&#8211;99 months&#41;&#59; 54 patients &#40;69&#46;2&#37;&#41; suffered falls from less than 3<span class="elsevierStyleHsp" style=""></span>m in height or banal injuries and 24 patients &#40;30&#46;8&#37;&#41; falls from more than 3<span class="elsevierStyleHsp" style=""></span>m in height or high energy-accidents&#46; According to the Sanders classification we operated 12 &#40;15&#37;&#41; type II&#44; 54 &#40;62&#46;8&#37;&#41; type III and 20 &#40;23&#46;2&#37;&#41; type IV fractures&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The postoperative mean AOFAS score was 73&#46;9 points&#44; with good or excellent results in 57&#37; of the patients&#46; Twelve cases &#40;14&#37;&#41; suffered surgical wound complications and 11 &#40;12&#46;8&#37;&#41; required subtalar arthrodesis&#46; Significantly better results were obtained in the patients younger than 30 years old&#44; patients that fell from less than 3<span class="elsevierStyleHsp" style=""></span>m in height and patients with Sanders fractures types II and III compared to type IV&#44; which were associated with higher rate of subtalar arthrodesis&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We consider that open reduction and internal fixation of intraarticular fractures of the calcaneus with reconstruction plate is a valid treatment alternative&#46; Given the complications described and the secondary subtalar arthrodesis rate&#44; we recommend a meticulous technique carried out by experienced surgeons&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Objective"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Material and methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Evaluar los resultados del tratamiento quir&#250;rgico de las fracturas intraarticulares de calc&#225;neo&#46; Analizar las variables que influyen en el resultado cl&#237;nico y radiol&#243;gico final&#44; as&#237; como las complicaciones dadas&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y m&#233;todos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Analizamos de forma retrospectiva 86 fracturas intraarticulares de calc&#225;neo en 78 pacientes&#44; intervenidas en nuestro servicio mediante abordaje lateral extendido y placa de reconstrucci&#243;n&#46; La edad media fue de 48 a&#241;os &#40;16-74 a&#241;os&#41; y el seguimiento medio de 4&#44;6 a&#241;os &#40;9-99 meses&#41;&#59; 54 pacientes &#40;69&#44;2&#37;&#41; sufrieron ca&#237;das de menos de 3 m de altura o traumatismos banales&#44; y 24 &#40;30&#44;8&#37;&#41; de m&#225;s de 3 m o accidentes de alta energ&#237;a&#46; Seg&#250;n la clasificaci&#243;n de Sanders&#44; intervinimos 12 fracturas &#40;15&#37;&#41; tipo II&#44; 54 &#40;62&#44;8&#37;&#41; tipo III y 20 &#40;23&#44;2&#37;&#41; tipo IV&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">La puntuaci&#243;n AOFAS media postoperatoria fue de 73&#44;9 puntos &#40;42-98 puntos&#41;&#44; con resultados buenos o excelentes en el 57&#37; de los casos&#59; 12 casos &#40;14&#37;&#41; presentaron complicaciones a nivel de la herida quir&#250;rgica y 11 &#40;12&#44;8&#37;&#41; precisaron una artrodesis subastragalina&#46; Obtuvimos resultados significativamente mejores en pacientes menores de 30 a&#241;os&#44; pacientes con ca&#237;das de menos de 3 m de altura y pacientes con fracturas tipos II y III de Sanders respecto a las tipo IV&#44; asoci&#225;ndose a estas una mayor tasa de artrodesis subastragalina&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Consideramos la reducci&#243;n abierta y fijaci&#243;n interna de las fracturas intraarticulares de calc&#225;neo con placa de reconstrucci&#243;n una alternativa vigente&#46; Dadas las complicaciones descritas y la tasa de artrodesis subastragalina secundaria&#44; recomendamos una t&#233;cnica meticulosa por parte de cirujanos experimentados&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Objetivo"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Material y m&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Diranzo-Garc&#237;a J&#44; Bert&#243;-Mart&#237; X&#44; Castillo-Ruiperez L&#44; Estrems-D&#237;az V&#44; Hern&#225;ndez-Ferrando L&#44; Villodre-Jim&#233;nez J&#44; et al&#46; Tratamiento de las fracturas intraarticulares de calc&#225;neo mediante placa de reconstrucci&#243;n&#46; Resultados y complicaciones de 86 fracturas&#46; Rev Esp Cir Ortop Traumatol&#46; 2018&#59;62&#58;267&#8211;273&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 641
            "Ancho" => 1400
            "Tamanyo" => 159272
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;A&#41; Reduction of the subtalar joint after removal of the lateral wall&#46; &#40;B&#41; Fracture fixation with low profile reconstruction plate&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figure 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
            "Alto" => 647
            "Ancho" => 1800
            "Tamanyo" => 88621
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Progression of Sanders type IV fracture to a subtalar arthrodesis following primary osteosynthesis&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">n&#58; number of patients&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Age</td><td class="td" title="table-entry  " align="left" valign="top">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Mean &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Median &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Range &#40;years&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16&#8211;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Gender</td><td class="td" title="table-entry  " align="left" valign="top">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;28&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">56 &#40;71&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Aetiology</td><td class="td" title="table-entry  " align="left" valign="top">Banal trauma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fall &#60;3<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Fall &#62;3<span class="elsevierStyleHsp" style=""></span>m&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Traffic accident&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">10 &#40;12&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;56&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">22 &#40;28&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;2&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Sanders classification</td><td class="td" title="table-entry  " align="left" valign="top">Type I&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Type II&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Type III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Type IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">0 &#40;0&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">12 &#40;15&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">54 &#40;62&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;23&#46;2&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Associated fractures</td><td class="td" title="table-entry  " align="left" valign="top">Rachis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Pelvis&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Upper limbs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Lower limbs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">9 &#40;11&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;3&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;10&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;11&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " rowspan="2" align="left" valign="top">Concomitant pathology</td><td class="td" title="table-entry  " align="left" valign="top">Tobacco habit&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Alcohol&#47;drugs&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">Psychiatric disorders&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">38 &#40;48&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;10&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;16&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1789261.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Demographic data of all patients&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">p value</span>&#58; statistical significance&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AOFAS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Global&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#62;3<span class="elsevierStyleHsp" style=""></span>m height&#47;high energy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">75&#46;59<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#60;3<span class="elsevierStyleHsp" style=""></span>m height&#47;banal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">73&#46;80<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">p value</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;029&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#62;30 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72&#46;07<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>10&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">&#60;30 years old&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">77&#46;06<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">p value</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;037</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sanders II&#8211;III&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">79&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Sanders IV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">67&#46;9<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">p value</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;001</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative B&#246;hler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>7&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative B&#246;hler&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27&#46;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">p value</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;023</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Preoperative Gissane&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>11&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Postoperative Gissane&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">118&#46;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>12&#46;02&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">p value</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top"><span class="elsevierStyleItalic">0&#46;014</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab1789260.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Correlation between functional outcomes and variables with statistically significant relevance&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:31 [
            0 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fracturas de calc&#225;neo&#58; controversias y consensos"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "M&#46; Herrera-P&#233;rez"
                            1 => "M&#46;J&#46; Guti&#233;rrez-Morales"
                            2 => "V&#46; Valderrabano"
                            3 => "M&#46; Wiewiorski"
                            4 => "J&#46;L&#46; Pais-Brito"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Pie Tobillo"
                        "fecha" => "2016"
                        "volumen" => "30"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The epidemiology of calcaneal fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46;J&#46; Mitchell"
                            1 => "J&#46;C&#46; McKinley"
                            2 => "C&#46;M&#46; Robinson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot &#40;Edinb&#41;"
                        "fecha" => "2009"
                        "volumen" => "19"
                        "paginaInicial" => "197"
                        "paginaFinal" => "200"
                        "itemHostRev" => array:3 [
                          "pii" => "S2213260017301297"
                          "estado" => "S300"
                          "issn" => "22132600"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "An economic evaluation of operative compared with nonoperative management of displaced intra-articular calcaneal fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46;A&#46; Brauer"
                            1 => "B&#46;J&#46; Manns"
                            2 => "M&#46; Ko"
                            3 => "C&#46; Donaldson"
                            4 => "R&#46; Buckley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2106/JBJS.E.00166"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2005"
                        "volumen" => "87"
                        "paginaInicial" => "2741"
                        "paginaFinal" => "2749"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16322625"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Age&#44; gender&#44; work capability&#44; and worker&#39;s compensation in patients with displaced intraarticular calcaneal fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "T&#46;V&#46; Tufescu"
                            1 => "R&#46; Buckley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Orthop Trauma"
                        "fecha" => "2001"
                        "volumen" => "15"
                        "paginaInicial" => "275"
                        "paginaFinal" => "279"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11371793"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1556086417328666"
                          "estado" => "S300"
                          "issn" => "15560864"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Manejo actual de las fracturas intraarticulares de calc&#225;neo"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46; L&#243;pez-Oliva"
                            1 => "F&#46; Forriol"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cir Ortop Traumatol"
                        "fecha" => "2011"
                        "volumen" => "55"
                        "paginaInicial" => "476"
                        "paginaFinal" => "484"
                        "itemHostRev" => array:3 [
                          "pii" => "S1556086415318633"
                          "estado" => "S300"
                          "issn" => "15560864"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Operative versus nonoperative treatment of displaced intra-articular calcaneal fracture&#58; a prospective&#44; randomized&#44; controlled multicenter trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "P&#46;H&#46; Agren"
                            1 => "P&#46; Wretenberg"
                            2 => "A&#46;S&#46; Sayed-Noor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2106/JBJS.L.00759"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2013"
                        "volumen" => "95"
                        "paginaInicial" => "1351"
                        "paginaFinal" => "1357"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23925738"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Operative versus nonoperative treatment for displaced intra-articular calcaneal fractures&#58; a meta-analysis of randomized controlled trials"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "X&#46; Luo"
                            1 => "Q&#46; Li"
                            2 => "S&#46; He"
                            3 => "S&#46; He"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1053/j.jfas.2016.01.035"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Foot Ankle Surg"
                        "fecha" => "2016"
                        "volumen" => "55"
                        "paginaInicial" => "821"
                        "paginaFinal" => "828"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27150233"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Wound healing complications in closed and open calcaneal fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;K&#46; Benirschke"
                            1 => "P&#46;A&#46; Kramer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Orthop Trauma"
                        "fecha" => "2004"
                        "volumen" => "18"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14676549"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures&#58; a prospective&#44; randomized&#44; controlled multicenter trial"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R&#46; Buckley"
                            1 => "S&#46; Tough"
                            2 => "R&#46; McCormack"
                            3 => "G&#46; Pate"
                            4 => "R&#46; Leighton"
                            5 => "D&#46; Petrie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2002"
                        "volumen" => "84-A"
                        "paginaInicial" => "1733"
                        "paginaFinal" => "1744"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12377902"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Operative treatment of displaced intra-articular calcaneal fractures&#58; long-term &#40;10&#8211;20 years&#41; results in 108 fractures using a prognostic CT classification"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Sanders"
                            1 => "Z&#46;M&#46; Vaupel"
                            2 => "M&#46; Erdogan"
                            3 => "M&#46; Downes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/BOT.0000000000000169"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Orthop Trauma"
                        "fecha" => "2014"
                        "volumen" => "28"
                        "paginaInicial" => "551"
                        "paginaFinal" => "563"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25243849"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advances in surgical management of intra-articular calcaneus fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;R&#46; Hsu"
                            1 => "R&#46;B&#46; Anderson"
                            2 => "B&#46;E&#46; Cohen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.5435/JAAOS-D-14-00287"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Orthop Surg"
                        "fecha" => "2015"
                        "volumen" => "23"
                        "paginaInicial" => "399"
                        "paginaFinal" => "407"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26111874"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Fracturas intraarticulares de calc&#225;neo&#46; T&#233;cnica quir&#250;rgica mediante abordaje lateral ampliado"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "A&#46; Dalmau-Coll"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Pie Tobillo"
                        "fecha" => "2012"
                        "volumen" => "26"
                        "paginaInicial" => "50"
                        "paginaFinal" => "58"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The operative management of displaced intra-articular fractures of the calcaneum&#58; a two-centre study using a defined protocol"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T&#46;D&#46; Tennent"
                            1 => "P&#46;R&#46; Calder"
                            2 => "R&#46;D&#46; Salisbury"
                            3 => "P&#46;W&#46; Allen"
                            4 => "D&#46;M&#46; Eastwood"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2001"
                        "volumen" => "32"
                        "paginaInicial" => "491"
                        "paginaFinal" => "496"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11476816"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of calcaneal fractures&#58; what have we learnt over the years&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "E&#46; Guerado"
                            1 => "M&#46;L&#46; Bertrand"
                            2 => "J&#46;R&#46; Cano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.injury.2012.05.011"
                      "Revista" => array:6 [
                        "tituloSerie" => "Injury"
                        "fecha" => "2012"
                        "volumen" => "43"
                        "paginaInicial" => "1640"
                        "paginaFinal" => "1650"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22664393"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intra-articular fractures of the calcaneus&#58; present state of the art"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46; Sanders"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Orthop Trauma"
                        "fecha" => "1992"
                        "volumen" => "6"
                        "paginaInicial" => "252"
                        "paginaFinal" => "265"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1602349"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Open reduction and internal fixation of calcaneal fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "E&#46; LeTournel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:5 [
                        "titulo" => "Topics in orthopedic surgery"
                        "paginaInicial" => "173"
                        "paginaFinal" => "192"
                        "edicion" => "1st ed&#46;"
                        "serieFecha" => "1984"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extensive intraarticular fractures of the foot&#58; surgical management of calcaneus fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "S&#46;K&#46; Benirschke"
                            1 => "B&#46; Sangeorzan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Orthop"
                        "fecha" => "1993"
                        "volumen" => "292"
                        "paginaInicial" => "128"
                        "paginaFinal" => "134"
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204517302395"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The mechanism and treatment of fractures of the calcaneus&#58; open reduction with the use of cancellous grafts"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "I&#46; Palmer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "1948"
                        "volumen" => "30"
                        "paginaInicial" => "2"
                        "paginaFinal" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Responsiveness and validity of the SF-36&#44; Ankle Osteoarthritis Scale AOFAS Ankle Hindfoot Score&#44; and Foot Function Index in end stage ankle arthritis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;J&#46; Madeley"
                            1 => "K&#46;J&#46; Wing"
                            2 => "C&#46; Topliss"
                            3 => "M&#46;J&#46; Penner"
                            4 => "M&#46;A&#46; Glazebrook"
                            5 => "A&#46;S&#46; Younger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3113/FAI.2012.0057"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Int"
                        "fecha" => "2012"
                        "volumen" => "33"
                        "paginaInicial" => "57"
                        "paginaFinal" => "63"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22381237"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation of the validity of the AOFAS clinical rating systems by correlation to the SF-36"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "N&#46;F&#46; SooHoo"
                            1 => "M&#46; Shuler"
                            2 => "L&#46;L&#46; Fleming"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/107110070302400108"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Int"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "50"
                        "paginaFinal" => "55"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12540082"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Secuelas de las fracturas de calc&#225;neo y encuesta nacional"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "F&#46; Noriega"
                            1 => "J&#46;M&#46; C&#225;ceres"
                            2 => "J&#46; Vil&#225;"
                            3 => "E&#46; Iglesias"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Cir Ortop Traumatol"
                        "fecha" => "2005"
                        "volumen" => "49"
                        "numero" => "Suppl&#46; 1"
                        "paginaInicial" => "78"
                        "paginaFinal" => "89"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Subtalar fusion after displaced intra-articular calcaneal fractures&#58; does initial operative treatment matter&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46;S&#46; Radnay"
                            1 => "M&#46;P&#46; Clare"
                            2 => "R&#46;W&#46; Sanders"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.2106/JBJS.G.01445"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Bone Joint Surg Am"
                        "fecha" => "2009"
                        "volumen" => "91"
                        "paginaInicial" => "541"
                        "paginaFinal" => "546"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19255213"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0169500217304014"
                          "estado" => "S300"
                          "issn" => "01695002"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Management of calcaneal malunion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Banerjee"
                            1 => "C&#46; Saltzman"
                            2 => "R&#46;B&#46; Anderson"
                            3 => "F&#46; Nickisch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Orthop Surg"
                        "fecha" => "2011"
                        "volumen" => "19"
                        "paginaInicial" => "27"
                        "paginaFinal" => "36"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21205765"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complications following management of displaced intra-articular calcaneal fractures&#58; a prospective randomized trial comparing open reduction internal fixation with nonoperative management"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46;L&#46; Howard"
                            1 => "R&#46; Buckley"
                            2 => "R&#46; McCormack"
                            3 => "G&#46; Pate"
                            4 => "R&#46; Leighton"
                            5 => "D&#46; Petrie"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Orthop Trauma"
                        "fecha" => "2003"
                        "volumen" => "17"
                        "paginaInicial" => "241"
                        "paginaFinal" => "249"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12679683"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204517304461"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Displaced intra-articular calcaneal fractures&#58; variables predicting late subtalar fusion"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46; Csziy"
                            1 => "R&#46; Buckley"
                            2 => "S&#46; Tough"
                            3 => "R&#46; Leighton"
                            4 => "J&#46; Smith"
                            5 => "R&#46; McCormack"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Orthop Trauma"
                        "fecha" => "2003"
                        "volumen" => "17"
                        "paginaInicial" => "106"
                        "paginaFinal" => "112"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12571499"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204516305654"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Chondrocyte viability after intra-articular calcaneal fractures in humans"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;T&#46; Ball"
                            1 => "K&#46; Jardin"
                            2 => "R&#46;T&#46; Allen"
                            3 => "A&#46;K&#46; Schwartz"
                            4 => "R&#46;L&#46; Sah"
                            5 => "M&#46;E&#46; Brage"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3113/FAI.2007.0665"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Int"
                        "fecha" => "2007"
                        "volumen" => "28"
                        "paginaInicial" => "665"
                        "paginaFinal" => "668"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17592695"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Primary subtalar arthrodesis for the treatment of comminuted calcaneal fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "B&#46;D&#46; Buch"
                            1 => "M&#46;S&#46; Myerson"
                            2 => "S&#46;D&#46; Miller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1177/107110079601700202"
                      "Revista" => array:6 [
                        "tituloSerie" => "Foot Ankle Int"
                        "fecha" => "1996"
                        "volumen" => "17"
                        "paginaInicial" => "61"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8919403"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The primary arthrodesis for severely comminuted intra-articular fractures of the calcaneus&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "T&#46; Schepers"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Foot Ankle Surg"
                        "fecha" => "2012"
                        "volumen" => "18"
                        "paginaInicial" => "84"
                        "paginaFinal" => "88"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Operative versus non-operative treatment for closed&#44; displaced&#44; intra-articular fractures of the calcaneus&#58; randomised controlled trial"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "UK Heel Fracture Trial Investigators"
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Griffin"
                            1 => "N&#46; Parsons"
                            2 => "E&#46; Shaw"
                            3 => "Y&#46; Kulikov"
                            4 => "C&#46; Hutchinson"
                            5 => "M&#46; Thorogood"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "BMJ"
                        "fecha" => "2014"
                        "volumen" => "349"
                        "paginaInicial" => "g4483"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25059747"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0305"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early wound complications of operative treatment of calcaneus fractures&#58; analysis of 190 fractures"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;W&#46; Folk"
                            1 => "A&#46;J&#46; Starr"
                            2 => "J&#46;S&#46; Early"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:7 [
                        "tituloSerie" => "J Orthop Trauma"
                        "fecha" => "1999"
                        "volumen" => "13"
                        "paginaInicial" => "369"
                        "paginaFinal" => "372"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10406705"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S1470204516306246"
                          "estado" => "S300"
                          "issn" => "14702045"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0310"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Radiographic and functional outcomes after displaced intra-articular calcaneal fractures&#58; a comparative cohort study among the traditional open technique &#40;ORIF&#41; and percutaneous surgical procedures &#40;PS&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "C&#46; Biz"
                            1 => "E&#46; Barison"
                            2 => "P&#46; Ruggieri"
                            3 => "C&#46; Iacobellis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1186/s13018-016-0426-6"
                      "Revista" => array:5 [
                        "tituloSerie" => "J Orthop Surg Res"
                        "fecha" => "2016"
                        "volumen" => "11"
                        "paginaInicial" => "92"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27550340"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/19888856/0000006200000004/v1_201807060854/S1988885618300373/v1_201807060854/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "7577"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original articles"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/19888856/0000006200000004/v1_201807060854/S1988885618300373/v1_201807060854/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1988885618300373?idApp=UINPBA00004N"
]

Article information

ISSN: 19888856
Original language: English

DOI:10.1016/j.recote.2018.04.007

The statistics are updated each day

Year/Month	Html	Pdf	Total

2024 November	17	0	17
2024 October	37	3	40
2024 September	36	3	39
2024 August	41	6	47
2024 July	63	4	67
2024 June	57	2	59
2024 May	29	3	32
2024 April	43	10	53
2024 March	49	7	56
2024 February	37	6	43
2024 January	62	13	75
2023 December	51	11	62
2023 November	30	7	37
2023 October	68	14	82
2023 September	27	4	31
2023 August	25	3	28
2023 July	28	3	31
2023 June	36	4	40
2023 May	73	10	83
2023 April	50	6	56
2023 March	31	3	34
2023 February	38	6	44
2023 January	37	9	46
2022 December	45	7	52
2022 November	48	17	65
2022 October	94	18	112
2022 September	89	16	105
2022 August	49	20	69
2022 July	34	6	40
2022 June	36	8	44
2022 May	44	10	54
2022 April	68	9	77
2022 March	108	8	116
2022 February	102	17	119
2022 January	101	15	116
2021 December	88	14	102
2021 November	52	12	64
2021 October	48	22	70
2021 September	49	13	62
2021 August	59	5	64
2021 July	31	6	37
2021 June	32	12	44
2021 May	28	7	35
2021 April	100	42	142
2021 March	68	22	90
2021 February	40	15	55
2021 January	26	10	36
2020 December	1	0	1

Show all

Indexed in:

Follow us:

Statistics

Indexed in:

Follow us:

Statistics

Subscribe to our newsletter