Minimally invasive treatment of calcaneal fracture by percutaneous leverage, anatomical plate, and compression bolts—the clinical evaluation of cohort of 156 patients

Qingxian Wang, Wei Chen, Yanling Su, Jinshe Pan, Qi Zhang, Aqin Peng, Xirui Wu, Pengcheng Wang, Yingze Zhang
Journal of Trauma 2010, 69 (6): 1515-22

OBJECTIVE: To introduce a minimally invasive procedure and investigate its clinical significance in the treatment of displaced intra-articular calcaneal fractures. This minimally invasive procedure consists of percutaneous leverage, manual compression, and fixation with anatomic plates and compression bolts through small lateral incisions.

METHODS: Two hundred ten feet with calcaneal fractures from 156 patients were managed by this minimally invasive procedure. According to Sanders classification, the fracture patterns in our study include 132 type II, 60 type III, and 18 type IV fractures. The Böhler's and Gissan's angle as well as the width, height, and length of the calcaneum were measured on pre- and postoperative radiographs. The anatomic plates were removed from 3 months to 12 months after operation for all patients. The Maryland hindfoot score system was applied to evaluate the postoperative function of the hindfoot.

RESULTS: All patients were followed up for an average of 9.7 months (range, 4.5-12 months). The reduction of the posterior articular facet was graded as nearly anatomic with articular displacement of < 3 mm in 159 fractures (75.7%). The reduction was measured radiologically by the change in the width, height, length of the calcaneum, and Böhler's and Gissan's angle, which have seen significant improvement in all patients. Based on the Maryland hindfoot score, 90 (43%) fractures was assessed as excellent, 90 (43%) good, 18 (8%) fair, and 12 (6%) poor. One hundred thirty-two patients (84.6%) were able to return to their original occupation at a mean time of 5.2 months (4.0-10.6 months) after operation. No patient sustained lateral impingement syndrome or soft tissue complications. Up to date, 20 patients (9.5%) sustained mild-to-moderate subtalar osteoarthritis, evidented radiologically as the narrowing of the joint space and subchondral sclerosis, but pain in the subtalar joint was present only in four patients (1.9%). No subtalar arthrodesis has been performed because of patients' unwillingness to undergo second procedure to relieve the pain that is well tolerable.

CONCLUSION: This minimal invasive procedure featured percutaneous leverage, manual compression, and the application of the anatomic plates and compression bolts through lateral approach is proved to be an effective treatment for displaced intra-articular calcaneal fracture, offering the combination of fewer soft tissue complications and good reduction. With < 3-mm displacement of the posterior facet after reduction, the restoration of the calcaneal width and height can be very important to achieve satisfactory radiologic and functional outcomes.

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