Medium-term clinical effects of minimally invasive percutaneous plate osteosynthesis for type sander Ⅲ, Ⅳ calcaneal fractures / 中国医师杂志

ABSTRACT

Objective:To compare minimally invasive percutaneous plate osteosynthesis (MIPPO) and open reduction and internal fixation via traditional lateral L-type approach (ORIF-LA) in the therapeutic effects concerning reduction and calcaneal alignment for Sanders Ⅲ/Ⅳ calcaneal fractures.Methods:A retrospective analysis was conducted of the 105 patients with calcaneal fracture who had been treated at Department of Foot and Ankle Surgery, Qilu Hospital from 2014.1 to 2018.2. Of them, 50 were treated with MIPPO (group A) and the other 55 with ORIF-LA (group B). The X-ray lateral and axial films, three-dimensional computed tomography (CT) of the calcaneal were taken pre-operatively and post-operatively to evaluate the reduction and calcaneal alignment. The American Orthopedic Foot Ankle (AOFAS) Ankle-Hind Foot Scale and Foot Function Index-Verbal Rating Scales (FFI-5pt) were adopted to assess the therapeutic effects. The postoperative complications of the two groups were compared.Results:All patients were followed up for 20-36 months (mean 24 months). The length of hospital stay and incision in group A was shorter than that in group B ( t=-11.276, -25.965, P<0.001). In group A and group B, the correction degrees of B?hler angle and Gissane angle were (34.49±3.81)°, (35.12±3.77)° and (-20.62±9.86)°, (-20.94±8.38)°, respectively ( P>0.05). Posterior calcaneal articular surface defects or steps in group A and group B were 1.55(1.12, 2.00)mm and 1.20(1.03, 1.60)mm, indicating that there was no significant difference in the reconstruction ability between the two groups ( P>0.05). There was no significant difference in VAS pain score between the two groups at 3 months after operation ( P>0.05), but group A was significantly lower than group B at 3 days after operation ( P<0.001). There was no significant difference in AOFAS and FFI-5pt scores between the two groups at 18 months after operation ( P>0.05). The complications of group A (6.0% incision infection, 2.0% incision area sensory disturbance, 2.0% foot stiffness) were lower than those of group B (16.36% incision infection, 14.55% incision area sensory disturbance, 10.9% foot stiffness) ( P<0.05). Conclusions:Compared with ORIF-LA, the MIPPO shows promising results in terms of reduction capacity and safety. Use of the MIPPO technique minimized the risk of postoperative wound complications and achieved superior functional outcomes compared with standard locking plate fixation via the extended lateral approach. MIPPO can be used as a choice for the treatment of calcaneal fracture.