Self-made calcaneal distraction device and percutaneous screw fixation at the key points for treatment of displaced intra-articular calcaneal fractures / 中华创伤杂志

ABSTRACT

Objective:To compare the clinical outcomes of percutaneous screw fixation at the key points using a self-made calcaneal distraction device with traditional open reduction plate internal fixation for the treatment of patients with displaced intra-articular calcaneal fractures (DIACFs).Methods:A retrospective case-control study was made on clinical data of 60 patients (69 feet) with DIACFs admitted to First Affiliated Hospital of Chongqing Medical University between January 2015 and January 2019. There were 51 males and 9 females, with an average age of 47.2 years [(47.2±8.7)years]. According to the Sanders classification, there were 42 feet of type II, 15 feet of type III and 12 feet of type IV. According to the Essex-Lopresti classification, there were 43 feet of tongue type fractures and 23 feet of joint depression fractures. Another 3 feet were not applicable to this classification system. In Group A, 30 patients (35 feet) were treated by percutaneous reduction or reduction using tarsal sinus approach with the self-made calcaneal distraction device followed by percutaneous screw fixation. In Group B, 30 patients (34 feet) were treated by open reduction and internal fixation with plates using the traditional extended lateral approach. Waiting time for surgery, operation time, length of hospital stay, efficacy of reduction and fracture healing, American Orthopedic Foot and Ankle Society (AOFAS) score, Maryland score, visual analog scale (VAS), and incidence of surgical site related complications were compared between groups. The efficacy of reduction was evaluated by measuring the height, length and width as well as the B?hler angle of the calcaneus.Results:All patients were followed up for an average of 28.2 months [(28.2±11.3)months]. The waiting time for surgery in Group A was (3.4±1.3)days, significantly shorter than that in Group B [(6.9±1.9)days] ( P<0.05). The operation time was (91.7±10.3)minutes in Group A and (92.8±11.5)minutes in Group B ( P>0.05). The length of hospital stay in Group A was (7.0±1.4)days, significantly shorter than that in Group B [(12.7±1.7)days] ( P<0.05). At the final follow-up, all fractures were healed, with no reduction loss of fixation observed. The height of the calcaneus was (48.9±2.0)mm in Group A and (49.3±2.6)mm in Group B ( P>0.05). The length of the calcaneus was (83.2±2.9)mm in Group A and (83.5±2.7)mm in Group B ( P>0.05). The width of the calcaneus was (35.8±2.3)mm in Group A and (35.1±1.3)mm in Group B ( P>0.05). The B?hler angle of the calcaneus was (24.7±6.4)° in Group A and (25.9±5.8)° in Group B ( P>0.05). At the final follow-up, the AOFAS score was (87.1±8.5)points in Group A and (86.7±7.8)points in Group B, with the good and excellent rate of 89% (31/35) and 88% (30/34) respectively ( P>0.05). The Maryland score was (85.3±9.5)points in Group A and (84.9±9.5)points in Group B, with the good and excellent rate of 86% (30/35) and 85% (29/34), respectively ( P>0.05). The VAS was (2.3±1.5)points in Group A and (2.5±1.5)points in Group B ( P>0.05). No surgical site related complication was observed in Group A. While in Group B, there was one foot of superficial incision infection, three necrosis of the skin at the edge of the incision, and one deep infection ( P<0.05). Conclusions:For the treatment of DIACFs, percutaneous screw fixation at the key point using the self-made calcaneal distraction device can achieve the same clinical outcome as traditional open reduction plate internal fixation, but it has advantages like significant shorter waiting time for surgery, less invasiveness, faster recovery and lower incidence of incision-related complications. This method is especially suitable for patients with contraindications of open reduction and internal fixation.