Minimally invasive plating via a small infero-fibular approach versus open reduction and internal fixation via an extended lateral approach in the treatment of intra-articular fractures of the calcaneus

Abstract

Objective To compare minimally invasive plating via a small infero-fibular approach versus open reduction and internal fixation via an extended lateral approach in the treatment of intra-articular fractures of the calcaneus. Methods A retrospective study was conducted to analyze the 92 patients who had been treated in our department for calcaneal fracture of Sanders type Ⅲ form March 2010 to March 2011.They were treated either by minimally invasive plating via a small infero-fibular approach (MI group) or by open reduction and internal fixation via an extended lateral approach (ORIF group).Only 17 pairs of the patients were included in the present study who were matched in sex,age and fracture type.The operation time,intraoperative and postoperative bleeding volume,fracture healing time and local complications for the 2 groups were documented.The therapeutic outcomes were compared between the 2 groups according to the evaluation system of American Orthopaedic Foot and Ankle Society (AOFAS),Visual Analogue Scale (VAS) pain score,and short form 36(SF-36). Results The MI group and the ORIF group obtained a mean follow-up of 14.2 months and of 15.3 months respectively.The MI group and the ORIF group had a mean operation Time of 84.0 ± 6.1 minutes and of 90.8 ± 5.4 minutes, a mean intraoperative and postoperative bleeding volume of 97.4 ± 10.6 mL and of 181.2 ± 10.9 mL,and a mean SF36 score of 60.2 ± 5.9 points and of 49.8 ± 5.0 points,respectively.There were significant differences between the 2 groups regarding the above indexes ( P ＜ 0.05).On average,there were no significant differences between the 2 groups regarding fracture healing time (9.5 ± 1.2 weeks versus 9.8 ± 1.4 weeks),AOFAS score (91.2 ± 6.6 points versus 88.7 ± 12.3 points) and VAS pain score ( 1.8 ± 0.7 points versus 1.9 ± 0.7 points) ( P ＞ 0.05).The MI group had one case of achilles tendon pain and the ORIF group had one case of incision infection and one case of delayed incision healing.There was no significant difference in complications between the 2 groups(x2 =3.000,P =0.223). Conclusion Compared with ORIF in the treatment of intra-articular fractures of the calcaneus,the minimally invasive plating via a small infero-fibular approach can better improve the quality of life of the patient without significant compromises in functional recovery and complications. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal; Surgical Procedures,minimally invasive