Session X1I - Foot and Ankle
Percutaneous Reduction and Fixation of Displaced Intra-articular Calcaneous Fractures
Purpose: The optimal treatment of displaced intra-articular calcaneal fractures (DIACF) is controversial. This is a retrospective cohort study to assess the initial results of percutaneous reduction and fixation (PC) compared to a concurrent control group treated with traditional open reduction and internal fixation (ORIF).
Methods: Between 2000 and 2004, 68 DIACF in 64 patients were treated operatively at a single institution by two surgeons with one of two methods. ORIF was performed through an extended lateral approach and fractures were fixed with plates and screws (24 fractures in 24 patients). PC was through small incisions, and the reduction achieved was secured with screws alone (44 fractures in 40 patients). Assignment to treatment groups was based on week of presentation. Risk factors were compared by chart review. Outcomes were complications of treatment identified by chart review and quality of reduction assessed on multiple lateral views by two of the investigators at three different sessions. Clinical outcomes will be measured by clinical examination at a research visit and patient outcome forms (SF-36, MFA, and VAS).
Results: The patients and the fractures in the two groups were not significantly different in aspects including sex (P=0.69), age (P=0.55), open fractures (P=0.24), Sanders classification, and initial Bohler's angle (P=0.46). Postoperative Bohler's angle was improved over the injury measurement by an average of 29.9° in the ORIF group and 26.3° in the PC group (P=0.29). The average loss of reduction was 7.1° with ORIF and 3.2° with PC (P=0.047). Deep infection (operative drainage and/or IV antibiotics) occurred in 5/24 of the ORIF group and 0/44 of the PC group (P=0.007). The incidence of minor wound complications was similar (3/24 and 3/44 respectively, P=0.73). Incidence of secondary operations including late subtalar fusions (2/24 and 1/44) and hardware removal (2/24 and 7/44) were also similar (P=0.58 and P=0.61 respectively).
Conclusion/Significance: The results of this study suggest that PC minimizes complications, while achieving and maintaining reductions as well as ORIF. The strength of this initial study of PC is the inclusion of a concurrent control group. However, the results should be interpreted with caution due to limited patient numbers, short follow-up, inability to measure articular reduction, and undetected confounding factors. In addition, the technique is demanding and may not easily generalize.