Comparison of open reduction and internal fixation by lateral extensile approach versus minimal invasive percutaneous fixation (Essex Lopresti) for the management of Sanders type 2 and 3 calcaneum fractures: a prospective, two-arm, parallel group study

Abstract

Background: Calcaneum is one of the most common tarsal bone to get fractured accounting for around 50-60% of all tarsal fractures. Due to lack of Indian studies comparing the outcomes of fracture calcaneus managed by operative methods of open reduction internal fixation (ORIF) versus the percutaneous minimal invasive approach (Essex Lopresti); we decided to conduct one such study. Methods: Adult patients with intra-articular Sander type 2 and 3 calcaneum fractures, managed by ORIF or Essex Lopresti were enrolled. The clinical outcomes (VAS score for pain, range of motion), radiological outcomes (Bohler’s and Crucial angle of Gissane) and functional outcomes (American orthopedic foot and ankle society (AOFAS) and Maryland foot score) were assessed at 6th month and 1-year post intervention and compared. Results: 117 patients managed with percutaneous fixation (n=63) or ORIF (n=54) were enrolled. Mean age of patients was 42.63±7.93 years. Mean VAS score was statistically comparable in both operative groups at 6th month and 1 year (p>0.05). Mean dorsiflexion and eversion angles were significantly higher in plating group at 6th month (p<0.05) while other movements were comparable in both the groups. Mean Bohler’s angle, Gissane’s angle, AOFAS and Maryland scores were found to be comparable in both groups (p>0.05) on follow-up. Both groups showed similar complications trend. Conclusions: Percutaneous fixation and plating methods were found to be comparable for calcaneus fracture management based on clinical, functional and radiological outcomes with similar complication rates.