SLR - March 2015 - Rebecca Sundling

Open Reduction and Internal Fixation Compared with ORIF and Primary Subtalar Arthrodesis for Treatment of Sanders Type IV Calcaneal Fractures: A Randomized Multicenter Trial

Reference: Buckley R, Leighton R, Sanders D, Poon J, Coles CP, Stephen D, Paolucci EO. Open Reduction and Internal Fixation Compared with ORIF and Primary Subtalar Arthrodesis for Treatment of Sanders Type IV Calcaneal Fractures: A Randomized Multicenter Trial. J Orthop Trauma. 2014 Oct;28(10); 577-83.

Scientific Literature Review

Reviewed By: Rebecca Sundling, DPM
Residency Program: Grant Medical Center, Columbus, Ohio

Podiatric Relevance: Calcaneal fractures are the most common tarsal bone fracture in the foot with 75 percent being intra-articular with the subtalar joint. These patients frequently go on to develop pain and stiffness, altering their lifestyles. Even despite surgical intervention, patients will often go on to a subtalar joint fusion. This article evaluated whether it is more beneficial for a patient to undergo ORIF alone or primary subtalar joint arthrodesis (PSTA) with ORIF.

Methods: Randomized multicenter trial conducted at four Level I trauma centers with five surgeons. The study included Sanders Type IV fractures with at least four articular fragments. Each patient underwent splinting and rest with CT prior to surgery. Thirty-one patients were included, age 18-59, with 17 undergoing ORIF only and 14 undergoing ORIF with PSTA. Surgery was conducted between six and 21 days after injury. Each group underwent post-operative x-rays and CT scan and was then followed for a minimum for two years. The ORIF group was non-weight bearing for 10 weeks while the ORIF + PTSA group was non-weight bearing for only six weeks. The SF-36, Musculoskeletal Functional Assessment, AOFAS Hindfoot Scale (AHS) and Visual Analogue Scale, as well as clinical and radiographic evaluations, were used to assess outcomes at each visit.     

Results: No statistical significant difference was found between the two groups in any of the measures. Mean post-operative Bohler’s Angle was 32.8 degrees -ORIF Group: 17 patients with 4 lost to follow up, leaving 13 patients. SF-36 score 30.2, MFA score 44.2, AHS 62.5, VAS 36.8 -ORIF + PTSA Group: 14 patients with onelost to follow up, leaving 13 patients. SF-36 score 37.8, MFA score 37.9, AHS 65.8, VAS 33.9.
       
Conclusions: The study was unable to demonstrate a statistically significant difference between the two treatment methods. However, the ORIF + PTSA group did have slightly higher scores, which could indicate a preference to this treatment method. The ORIF + PTSA group may also be advantageous as they returned to activity faster and would potentially require less surgery in the long run. Due to the low numbers in the study, further research is recommended. 

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