Locking plate internal fixation for minimally invasive treatment of intra-articular calcaneal fractures

Abstract

Objective To summarize and evaluate the technique and clinical outcome of limited tarsal sinus incision plus locking plate internal fixation for minimally invasive treatment of intra-articular calcaneal fractures. Methods Between February 2010 and February 2011,16 cases of intra-articular calcaneal fractures were treated in a minimally invasive manner in our department. All cases were evaluated carefully with routine X-rays and CT scans preoperatively to define the type of fracture and the involvement of articular surface.Open reduction and locking plate internal fixation with percutaneous screws were performed via a limited tarsal sinus approach 3 to 6 days after injury (average,4 days).Regular X-ray follow-ups were conducted to measure the Bohler's and Gissane angles.Overall functional evaluation was carried out according to Visual Analogue Scale (VAS),the Hind-foot Score by American Orthopaedic Foot and Ankle Society (AOFAS) and Short Form 36 Health Survey Questionnaire (SF-36).Complications were recorded as well.Results The 13 cases were followed up for a mean duration of 18 months (from 12 to 24 months).There were no wound infection,skin and flap necrosis or implant failure.Bone union was achieved at an average of 10 weeks (from 8 to 12 weeks) post-operatively.The average Bohler's angle was improved significantly from 13.4° ± 3.4° (from 8° to 19°) pre-operatively to 26.5° ± 4.5° ( from 21° to 38°) post-operatively ( t =9.781,P ＜ 0.001 ).The average Gissane angle was improved significantly from 88.1° ± 7.6° (from 77° to 100°)pre-operatively to 116.2°±7.5° (from 100°to 124°) post-operatively (t =12.934,P ＜0.001).On average,the VAS score was 1.5 ± 1.7,the AOFAS score was 84.2 ± 5.9 and the SF-36 score was 79.5 ± 8.1 at the final follow-up.The follow-ups revealed no post-traumatic arthritis. Conclusion Open reduction and locking plate fixation with percutaneous screws via a limited tarsal sinus incision is a safe and reliable treatment for intra-articular calcaneal fractures,because it has the advantages of direct reduction of the articular surface,solid fixation,and limited soft tissue complications. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal; Bone plates; Surgical procedures, minimally invasive