Treatment of displaced intra-articular calcaneal fractures with Orthofix external fixation

Abstract

Objective To evaluate clinical outcomes of treating displaced intra-articular calcaneal fractures with Orthofix external fixation (EF) in comparison with open reduction and internal fixation (ORIF). Methods Between February 2013 and December 2014, 39 patients with 41 calcaneal fractures were treated operatively and fully followed up at our department. They were 27 men and 12 women, aged from 27 to 56 years(average, 42.5 years). The left foot was affected in 15 cases and the right in 26. By the Sanders classification, there were 11 cases of type Ⅱ, 22 ones of type Ⅲ and 8 ones of type Ⅳ. The 5 open fractures were Gustilo type Ⅰ (2 cases) and Gustilo type Ⅱ (3 cases). Of the 11 fractures complicated with soft tissue injury, 4 were Tscherne-Oestern typeⅠ and 7 Tscherne-Oestern type Ⅱ. The patients were divided into group EF (25 cases) and group ORIF (16 cases) according to the operation they had received. The 2 groups were compared in intraoperative indexes and follow-up radiological data. The American Orthopaedic Foot and Ankle Society (AOFAS) scores for ankle and hindfoot were recorded at the final follow-up for every patient. Results The mean duration of surgery, intraoperative bleeding, time for hospitalization and bone healing in group EF were significantly less than in group ORIF (P 0.05). According to the AOFAS scores at the final follow-ups, 15 cases were rated as excellent, 8 as good and 2 as fair in group EF while 10 were rated as excellent, 5 as good and one as fair in group ORIF. Conclusions All types of calcaneal fracture can be treated using Orthofix external fixation which may lead to advantages of earlier surgery regardless of soft tissue condition, minimal invasiveness with less devascularization to the calcaneus and decreased risk of complications, and good clinical outcomes. Key words: Calcaneus; Fractures, open; Fracture fixation