Abstract
BackgroundThe management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial. A prospective randomized controlled trial was conducted to compare percutaneous reduction, cannulated screw fixation and calcium sulfate cement (PR+CSC) grafting with minimally invasive sinus tarsi approach and plate fixation (MISTA) for treatment of DIACFs.MethodsUltimately, 80 patients with a DIACFs were randomly allocated to receive either PR+CSC (N = 42) or MISTA (N = 38). Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores. Radiological results were assessed using plain radiographs and computed tomography (CT) scans, and postoperative wound-related complications were also recorded.ResultsThe average time from initial injury to operation and the average operation time in the PR+CSC group were both significantly shorter than those in the MISTA group (p < 0.05). There were significantly fewer complications in the PR+CSC group than those in the MISTA group (7.1 % vs 28.9 %, p < 0.001). The calcaneal width immediate postoperatively and at the final follow-up in the MISTA group were obviously improved compared to those in the PR+CSC group (p < 0.001). The variables of sagittal motion and hindfoot motion of the AOFAS scoring system in the PR+CSC group were significantly higher than those in the MISTA group (p < 0.05). The good and excellent results in the two groups were comparable for Sanders Type-II calcaneal fractures, but the good to excellent rate in the MISTA group was significantly higher for Sanders Type-III fractures (p < 0.05).ConclusionThe clinical outcomes are comparable between the two minimally invasive techniques in the treatment of Sanders Type-II DIACFs. The PR+CSC grafting is superior to the MISTA in terms of the average time between initial injury and operation, operation time, wound-related complications and subtalar joint activity. However, the MISTA has its own advantages in improving the calcaneal width, providing a more clear visualization and accurate reduction of the articular surface, especially for Sanders Type-III DIACFs.Trial registrationChiCTRIOR16008512. 21 May 2016.
Highlights
The management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial
Forty-two patients were treated with percutaneous reduction, cannulated screw fixation and calcium sulfate cement (CSC) grafting (PR+CSC group), and 38 patients were treated with a b c
The percutaneous reduction, cannulated screw fixation and CSC grafting for treatment of Sanders Type-II
Summary
A prospective randomized controlled trial was conducted to compare percutaneous reduction, cannulated screw fixation and calcium sulfate cement (PR+CSC) grafting with minimally invasive sinus tarsi approach and plate fixation (MISTA) for treatment of DIACFs. The management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial [1]. In an attempt to lower the complication rate, various minimally invasive techniques have recently been introduced, including external fixation, percutaneous fixation, arthroscopically assisted fixation, and minimal incision techniques via medial, modified lateral (such as the sinus tarsi approach), longitudinal, or combined approaches [8,9,10,11,12,13,14] These techniques have been reported as effective in minimizing soft tissue trauma, thereby reducing the incidence of woundrelated complications. The purpose of the present study was to compare the functional and radiological outcomes and complications of our percutaneous reduction, cannulated screw fixation and CSC grafting with those of the minimally invasive sinus tarsi approach and plate fixation for treatment of DIACFs
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