Comparison of percutaneous distractor and arthroscopic-assisted screw fixation with open reduction and plate fixation for Sanders II calcaneal fractures treatment: A single-center retrospective cohort study

Abstract

BackgroundAlthough the numerous advancements in orthopedic surgical techniques and implants witnessed in recent decades, the management of calcaneus fractures remains among the most complex challenges in the field. This study introduced a percutaneous distractor and arthroscopic-assisted screw fixation (PDA-CRSF) technique and compared its wound-related complications and clinical efficacy with open reduction and plate fixation with sinus tarsi approach (STA-ORPF) for treating Sanders II calcaneal fractures. Patients and methodsThis retrospective cohort analysis evaluated two patient cohorts with Sanders II calcaneal fractures received either STA-ORPF or PDA-CRSF using clinical indicators time to operation, operation duration, blood loss volume, hospital stay, wound healing complications, nerve damage, American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot score, Visual Analogue Scale (VAS) score, and imaging indicators Gissane's angle (GA), Böhler's angle (BA), varus angle (VA), the length, height and width of calcaneal fractures, respectively. ResultsBetween March 2019 and March 2022, 23 patients underwent PDA-CRSF and 49 under STA-ORPF. The STA-ORPF group had fewer wound complications and nerve damage compared to the PDA-CRSF group (P < 0.05). Furthermore, the PDA-CRSF group exhibited shorter time to operation, reduced operation duration, decreased blood loss volume, and shorter hospital stay (P < 0.01). Three months after surgery, patients treated with PDA-CRSF also showed better scores on AOFAS (P < 0.01) and VAS (P < 0.05). However, at the final follow-up, the difference was not statistically significant (P = 0.222; P = 0.118). Both groups regarding radiographic indices had comparable outcomes at different postoperative follow-up stages. ConclusionThe results demonstrate that PDA-CRSF effectively reduces the risk of wound complications, shortens the surgical duration, expedites the time to surgery, and enhances post-operative rehabilitation.