SLR - April 2020 - Alana A. Marconi

Percutaneous Reduction and Screw Fixation for All Types of Intra-articular Calcaneal Fractures

Reference: Ebrahimpour A, Kord MHC, Sadighi M, Chehrassan M, Najafi A, Sajjadi MM.  Percutaneous Reduction and Screw Fixation for All Types of Intra-articular Calcaneal Fractures. Musculoskelet Surg. 2020 Jan 6.

Scientific Literature Review

Reviewed By: Alana A. Marconi, DPM  
Residency Program: Northwell Health Long Island Jewish Forest Hills Hospital – Queens, NY 

Podiatric Relevance: Intra-articular calcaneal fractures are one of the more challenging podiatric procedures to treat. They are typically treated surgically by means of open reduction internal fixation. However, ORIF has its complications such as increased risk of wound dehiscence and infection, especially in the lateral hindfoot as there is less soft tissue density. This study evaluated the clinical and functional outcomes in patients who underwent closed reduction internal fixation compared to open reduction internal fixation in 88 intra-articular calcaneal fractures.

Methods: A prospective comparison study was performed on 88 patients with unilateral displaced intra-articular calcaneal fractures. All patients had  standard radiographic and CT evidence of Sanders type II or III or IV fractures. Thirty-nine patients received classic open reduction internal fixation (ORIF) with a lateral extensile L-shaped approach utilizing a calcaneus anatomic plate and screws. Forty-nine patients received closed reduction internal fixation (CRIF) involving multiple percutaneous cannulated screws. Primary clinical outcomes included operation duration, postoperative pain via VAS wound dehiscence, and infection. Functional outcomes were measured using the AOFAS Ankle-Hindfoot scale and Short Form-36 questionnaire. Ability to return to work and radiographs at one year was evaluated as well.

Results: There were no statistically significant differences in baseline characteristics such as age, sex, injury mechanism or Sanders classification. The CRIF group had a much shorter operation duration, shorter hospital stay, and a significantly shorter amount of time needed to return to work. The prevalence of wound complications was much lower in the CRIF group and was statistically significant. At the last follow up visit a year after the surgery AOFAS ankle hindfoot, SF-36 scores, and radiographic measures were not significantly different between the two groups.

Conclusions: The authors found no significant differences in radiographic results between groups showing similar restoration of joint congruity. They found the CRIF group to have a shorter operation duration, shorter hospital stay and significantly shorter amount of time needed to return to work. The CRIF group also had significantly less wound complications which is expected with a minimally invasive approach. Patients who were smokers or diabetics were placed in the CRIF group which make the results more impressive than if they had been randomly separated. Overall this article shows percutaneous reduction to be a beneficial option for intra-articular calcaneal fractures and can lead to better outcomes, especially in patients with multiple comorbidities.  

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