Abstract
Background: Percutaneous reduction with fixation and open reduction internal fixation are often used to treat intra-articular calcaneus fractures with no consensus on the preferred method. Open techniques have been associated with an increased risk of wound complications, while percutaneous techniques may result in inferior reduction capabilities. These injuries pose a challenge to patients as they often result in poor patient outcomes. We retrospectively analyzed patient outcomes of a single surgeon’s experience in treating these injuries at a busy urban Level 1 trauma center. Methods: Patients with intra-articular calcaneus fractures managed operatively over 10 years with a minimum six-month follow-up were included. Patients were divided into two cohorts based on operative technique: closed reduction and percutaneous fixation (CRPF) or open reduction internal fixation (ORIF). Descriptive analysis of each cohort included postoperative infection, the need for repeat operations, development of post-traumatic subtalar arthritis, and reduction capabilities as assessed by Bohler’s angle. Results: Sixty-two patients were included in this study, with 33 patients in the CRPF group and 29 patients in the ORIF group. Infection requiring a return to the operating room occurred in 1 (3%) CRPF and 7 (24%) ORIF patients. Instrumentation was removed in 23 (70%) CRPF and 9 (31%) ORIF patients. Clinical subtalar arthritis developed in 10 (30%) CRPF and 7 (24%) ORIF patients, requiring arthrodesis in 2 (6%) and 5 (17%) patients, respectively. Both techniques had acceptable restoration of Bohler’s angle immediately postoperatively and at final follow-up. Conclusions: Percutaneous reduction with fixation and open reduction internal fixation may both be considered for the surgical treatment of intra-articular calcaneal fractures. Indications for each technique may vary between surgeons, and each has its own set of risk factors and complications, however, both have been shown to result in an acceptable reduction. Level of Evidence: Level IV.
Highlights
The annual incidence of calcaneus fractures is approximately 11.5 per 100,000, representing nearly 2% of all fractures [1]
Twenty-nine fractures were treated with open reduction internal fixation (ORIF), and 33 fractures were treated with closed reduction and percutaneous fixation (CRPF)
This study found a higher number of infections in the ORIF cohort, and infection was often associated with smoking status and the presence of diabetes in both groups
Summary
The annual incidence of calcaneus fractures is approximately 11.5 per 100,000, representing nearly 2% of all fractures [1]. Calcaneal fractures can lead to severe long-term pain and disability, making proper management critical. The goal of calcaneal fracture treatment, as defined by the American Orthopedic Foot and Ankle Society (AOFAS), is to restore the normal alignment and contour of the calcaneus. This is achieved by restoring heel height and length (frequently determined by the measurement of Bohler’s angle), the realignment of the posterior facet of the subtalar joint, and restoring the mechanical axis of the foot [1]. Current indications for operative treatment include displaced intra-articular posterior facet fractures, anterior process
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