J Korean Foot Ankle Soc.  2020 Jun;24(2):87-93. 10.14193/jkfas.2020.24.2.87.

Clinical Results of Surgical Treatment with Minimally Invasive Percutaneous Plate Osteosynthesis for Displaced Intra-articular Fractures of Calcaneus

• Suh JW
• Yang JH
• Park HW

• KMID: 2502915
• DOI: http://doi.org/10.14193/jkfas.2020.24.2.87

Abstract

Purpose
This study evaluated the clinical results of surgical treatment with minimally invasive plate osteosynthesis for treating displaced intra-articular fractures of the calcaneus in comparison with conventional lateral extensile approach plate osteosynthesis.
Materials and Methods
Of 79 cases of Sanders type II or III calcaneus fractures, 15 cases treated with the minimally invasive calcaneal plate (group M) and 64 cases treated with lateral extensile approach calcaneal plate (group E) were identified. After successful propensity score matching considering age, sex, diabetes mellitus history, and Sanders type (1:3 ratio), 15 cases (group M) and 45 cases (group E) were matched and the demographic, radiologic, and clinical outcomes were compared between the two groups.
Results
The median time of surgery from injury was 2.0 days in group M and 6.0 days in group E (p=0.014). At the six months followup, group M showed results comparable with those of group E in radiographic outcomes. In the clinical outcomes, group M showed better postoperative American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores than did group E (p=0.001, p=0.008). A greater range of subtalar motion was achieved at the six months follow-up in group M (inversion 20.0° vs. 10.0°, p=0.002; eversion 10.0° vs. 5.0°, p=0.025). Although there were no significant differences in complications between the two groups (1 [6.7%] vs. 7 [15.6%], group M vs. group E; p=0.661), there was only one sural nerve injury and no wound dehiscence and deep infection in group M.
Conclusion
Minimally invasive plate osteosynthesis showed superior clinical outcomes compared with that of the conventional lateral extensile approach plate osteosynthesis in Sanders type II or III calcaneus fractures. We suggest applying minimally invasive plate osteosynthesis in Sanders type II or III calcaneus fractures.

Keyword

Calcaneus; Intra-articular fracture; Minimally invasive surgical procedures; Open fracture reduction; Complications

Figure

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  Figure. 1 Methods of measurement of the calcaneal parameters in radiographs. (A) Böhler angle (BA) and calcaneus length (L); and (B) Gissane angle (GA) and calcaneus height (H) in calcaneus lateral radiographs. (C) Calcaneus width (W) in calcaneal axial radiograph.

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  Figure. 2 Postoperative and radiograph (A) and intraoperative photograph (B) show internal fixation with percutaneous plate using minimally invasive approach.

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  Figure. 3 Postoperative radiograph (A) and intraoperative photograph (B) show internal fixation with conventional plate using extensile lateral approach.

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