Minimally invasive dual incision with mini plate internal fixation improves outcomes over 30\u2009months in 20 patients with Sanders type III calcaneal fractures

Jianming Chen,Zhongmeng Yang,Changwang Kong,Shijun Wei

doi:10.1186/s13018-020-01644-3

Abstract

BackgroundCalcaneal Sanders type III or higher fractures traditionally have been treated with open reduction and internal fixation (ORIF); however, ORIF has associated complications. We investigated a combination of minimally invasive dual incision and internal fixation using mini plates for treating Sanders type III calcaneal fractures.MethodsTwenty patients with Sanders type III intra-articular calcaneal fractures with a posterior subtalar articular displacement > 2 mm were included. Surgical outcomes were assessed by visual analogue scale (VAS) pain score, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and calcaneal geometry, including Böhler and Gissane angles.ResultsThe Böhler angle, Gissane angle, and height and length of the calcaneus were increased following treatment. Based on the AOFAS score, 80% of cases had excellent or good outcomes. The mean postoperative VAS pain score was 1.6. Complications such as malunion or a screw positioning deviation occurred in 6 patients, and one patient experienced delayed wound healing. There were no wound infections.ConclusionsThese results indicate that minimally invasive dual incision with mini plate internal fixation may be an effective alternative to ORIF for treating Sanders type III calcaneal fractures. Advantages include improvement of calcaneal geometry and a lower rate of wound infections.

Highlights

Calcaneal Sanders type III or higher fractures traditionally have been treated with open reduction and internal fixation (ORIF); ORIF has associated complications
Operative treatment of calcaneal fractures by open reduction and internal fixation (ORIF) has been the gold standard treatment for decades; ORIF is associated with complications including wound infection, wound dehiscence, flap devascularization, and injury to the sural nerve [10, 11]
This study demonstrated that Sanders type III calcaneal fractures can be successfully treated with minimally invasive dual incision and mini plate internal fixation

Summary

Introduction

Calcaneal Sanders type III or higher fractures traditionally have been treated with open reduction and internal fixation (ORIF); ORIF has associated complications. We investigated a combination of minimally invasive dual incision and internal fixation using mini plates for treating Sanders type III calcaneal fractures. 20% of patients with intra-articular calcaneal fractures will be unable to return to work within 1 year, which has significant social and economic consequences [2, 3]. Because intra-articular calcaneal fractures involve the subtalar joint surface, they typically cause an increase in calcaneal width and decreases in the Böhler and Gissane angles. Indications for closed reduction include Sanders 2C tongue-type fractures, displaced calcaneal tuberosity fractures, temporary stabilization of fractures with severe soft tissue compromise, and fractures in patients with relative contraindications to open surgery. The ideal treatment for calcaneal fractures that do not meet the criteria for closed reduction is not clear [8, 9]

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