SLR - July 2019 - Matthew Weintraub

Reduction and Functional Outcome of Open Reduction Plate Fixation Versus Minimally Invasive Reduction with Percutaneous Screw Fixation for Displaced Calcaneus Fracture: A Retrospective Study

Reference:
Reduction and Functional Outcome of Open Reduction Plate Fixation Versus Minimally Invasive Reduction with Percutaneous Screw Fixation for Displaced Calcaneus Fracture: A Retrospective Study. Ye Peng , Jianheng Liu, Gongzi Zhang, Xinran Ji, Wei Zhang, Lihai Zhang, Peifu Tang. J Orthop Surg Res. 2019 May 9;14(1):124. doi: 10.1186/s13018-019-1162-5.

Scientific Literature Review

Reviewed By: Matthew Weintraub, DPM
Residency Program: University Hospital – Newark, NJ

Podiatric Relevance: In the world of surgery, minimally invasive techniques are becoming increasingly popular. Podiatric surgery is no exception to this trend. Specifically, with regards to displaced calcaneal fractures, the paradigm has been shifting towards minimally invasive techniques as there are less concerns for wound complications compared to the gold standard, lateral extensile approach. Whether minimally invasive techniques allow for adequate reduction of displaced calcaneal fractures has been a topic of debate. This study aimed to evaluate and compare the reduction and clinical outcomes of closed reduction and percutaneous fixation (minimally invasive) treatment with the gold standard, open reduction and plate fixation utilizing the lateral extensile approach.

Methods: A retrospective study was completed which consisted of 45 feet with calcaneus fractures from 2012 to 2016. The open reduction plate fixation group was compared to the closed reduction percutaneous fixation group. The closed reduction percutaneous fixation group utilized a traction device in order to distract the joint during intraoperative closed reduction. The reduction assessments included: length, width, height, Bohler’s angle, Gissane’s angle, varus/valgus angle before and after surgery. Clinical outcomes were analyzed utilizing the AOFAS hindfoot score, VAS score, length of stay, and complication rate.

Results: Both groups were followed up for an average of 16.53 ± 3.95 months. Of most importance, there was no statistically significant difference in quality of reduction between the two groups in this study. The AOFAS scores of the two groups were 80.29 ± 6.15 (open) and 83.62 ± 6.95 (closed). The VAS scores of the open and closed groups were 1.50 ± 1.22 and 0.81 ± 0.87; however, the VAS scores were obtained on postoperative day one, which may have skewed the results as the open reduction group would knowingly have more pain postoperatively given the surgical technique. The lengths of stay in the open and closed groups were 9.63 ± 2.72 days and 6.71 ± 1.85 days. The complication rates of the open and closed groups were 20.8 percent and 4.8 percent (statistically significant).

Conclusions: According to this study, closed reduction percutaneous fixation of displaced calcaneal fractures may allow for a similar quality of reduction as compared to the gold standard, lateral extensile approach. Bilateral traction devices may help to provide these closed reductions.This study found that the VAS scores and lengths of stay were both lower with statistical significance in the closed reduction group; however, neither of these findings are surprising as the VAS score was obtained only one day after surgery and the time to surgery on average was more than doubled (1-3 days vs 7-10 days) in the open reduction group. Of most importance, there was no statistically significant difference in quality of reduction between the two groups in this study when utilizing radiographic parameters length, width, height, Bohler’s angle, Gissane’s angle, varus/valgus angle before and after surgery. When considering surgery for displaced calcaneal fractures, minimally invasive techniques may allow for similar reductions while avoiding the significant risk of would complications that comes along with more traditional open reduction techniques.  

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