Résumé
BACKGROUND: Intra-calcaneal fractures involving subtalar joints account for about 75% of all calcaneal fractures. Surgical treatment of displaced intra-articular calcaneal fractures is superior to non-surgical treatment. However, the timing of treatment, surgical indications, incision selection, and bone grafting are still controversial. The classical “L” approach is gradually replaced by minimally invasive internal fixation because of its high incision complications. OBJECTIVE: To compare the clinical effect of minimally invasive internal fixation and “L” incision for the treatment of Sanders II and III calcaneal fractures. METHODS: Sixty patients with Sanders II or III calcaneal fractures from January 2016 to January 2019 in the Second Department of Orthopedics, Shantou Hospital of Traditional Chinese Medicine were randomly divided into minimal invasion group (n=32) and “L” incision group (n=28). The patients in the minimal invasion group and “L” incision group received percutaneous reduction by leverage combined with minimally invasive internal fixation and “L” incision internal fixation treatment, respectively. At 6 months after operation, the curative effect of the two groups was evaluated according to the American Orthopedic Foot and Ankle Society score. Preoperative waiting days, the operation time, the length of stay and the complication incidence were compared between the two groups. Bfihler angle and Gissane angle were measured and compared preoperatively, postoperatively and during the final follow-up. RESULTS AND CONCLUSION: (1) The excellent and good rate of American Orthopedic Foot and Ankle Society score was 91% in the minimal invasion group and 93% in the “L” incision group (P > 0.05). (2) The postoperative Bohler angle and Gissane angle were significantly improved in both groups (P 0.05). Bohler angle was better in the “L” incision group than in the minimal invasion group (P 0.05). (3) The preoperative waiting days and the length of stay were longer in the “L” incision group than those in the minimal invasion group (P < 0.05). The operation time was shorter in the “L” incision group than in the minimal invasion group (P < 0.05). (4) The incidence of complications was lower in the minimal invasion group (9%) than in the “L" incision group (32%) (P < 0.05). (5) Compared with the traditional “L” incision open reduction and internal fixation, the treatment of Sanders II and III calcaneal fractures with percutaneous reduction by leverage combined with minimally invasive internal fixation are satisfactory, with less trauma and complications. It is worth being recommended in clinic.