Comparison between Percutaneous Screw Fixation and Plate Fixation via Sinus Tarsi Approach for Calcaneal Fractures: An 8–10‐Year Follow‐up Study

Abstract

Objective To assess the long‐term outcomes after percutaneous reduction (PR) and screw fixation versus plate fixation via the sinus tarsi approach (STA) for displaced intra‐articular calcaneal fractures (DIACF). Methods This retrospective study included a total of 150 patients (June 2008–August 2011), comprising 85 men and 65 women (mean age, 38.4 years), who were assigned to the PR group or the STA group. The inclusion criteria were DIACF (>2 mm) including Sanders type II and III, closed fracture, unilateral fracture, no history of smoking or no smoking during hospitalization and 3 months after surgery, and follow‐up time not less than 8 years. The exclusion criteria were clear surgical contraindications (severe cardiovascular and cerebrovascular diseases), local or systemic infection symptoms, diagnosis with diabetes or lower extremity vascular disease, and Sanders type IV or open fractures. Outcomes were assessed by means of the American Orthopedic Foot and Ankle Society (AOFAS) hindfoot scores, radiographic images, and postoperative complications. Results The mean follow‐up period was 8.7 years (range, 8.0–10.0 years). The AOFAS scores in the PR group during the follow‐up period were 54.2 ± 5.1, 85.8 ± 4.0, 88.1 ± 3.8, 87.9 ± 3.6, 87.8 ± 3.9, 86.9 ± 3.9, respectively, and in the STA group were 55.0 ± 5.6, 84.5 ± 5.2, 87.1 ± 3.8, 86.9 ± 3.8, 87.7 ± 3.3, and 87.6 ± 2.8, respectively. There was no significant difference in AOFAS scores, Bohler's angle, Gissane's angle, calcaneal length, and height between the two groups (P > 0.05). The good to excellent rate of the PR group (80.8%) was less than that of the STA group (91.7%) (P = 0.055). For Sanders III fractures, the good to excellent rate of the PR group (33.3%) was less than that of the STA group (76.9%) (P = 0.029). For calcaneal width recovery, the STA group performed better than the PR group (P < 0.05). The incidence of postoperative complications in the PR group (12.8%) was lower than that in the STA group (27.8%) (P = 0.026), of which the incidence of wound complications was 3.8% in the PR group and 13.9% in the STA group (P = 0.041). In addition, there was no significant difference in other postoperative complications such as sural nerve injury, peroneus longus and brevis muscle injury, calcaneal valgus symptoms, lateral impingement symptoms, and subtalar arthritis (P > 0.05). Conclusion From the 8–10‐year follow‐up results of PR and STA as surgical procedures for the treatment of DIACF, it was found that there was no significant difference in the overall efficacy between them. STA was found to be superior to the PR in terms of the recovery of calcaneal width, providing more stable fixation for Sanders III fractures. PR was found to be more effective in reducing wound complications.

RETRACTION: Open reduction internal fixation versus minimally invasive percutaneous fixation for calcaneus fractures: Mid-term outcomes and social consequences

“…The authors found no statistically significant difference in the postoperative AOFAS scores. In another clinical study reported by Weng et al, [23] similar results were achieved. In our study, there was no statistically significant difference between the two groups in terms of the AOFAS, MFS, and the SF-36 scores at the first, second, and third postoperative years.…”

Cannulated screw fixation versus plate fixation in treating displaced intra-articular calcaneus fractures: a systematic review and meta-analysis

“…1). We totally identified 736 unique studies after searching the electronic databases, and only seven RCTs were finally included in the meta-analysis [19][20][21][22][23][24][25]. All seven studies compared the effectiveness of cannulated screw fixation and plate fixation for DIACFs.…”

“…The CSF group contained 457 patients, and the plate fixation group contained 445 patients. Four RCTs [20,21,24,25] included Sanders types II, III, and IV, and three RCTs [19,22,23] only included Sanders types II and III. Details of included studies are presented in Table 1.…”

“…AOFAS score Three studies [19,22,25] compared the post-operative AOFAS score of the two fixation methods. Pooled result in Fig.…”

“…Improvement of Bohler's angle All seven studies [19][20][21][22][23][24][25] compared the improvement of Bohler's angle between the two fixation methods. Pooled result in Fig.…”