Comparison of LCP and Intramedullary Nail Osteosynthesis in Calcaneal Fractures

Abstract

Objective:This study compared groups of patients with calcaneal fractures of Sanders types II and III. One group was treated with ORIF using an LCP (plate), while the second was treated with a minimally invasive method using a C-Nail.Methods:The study included 217 patients in the ORIF group and 19 patients in the minimally invasive nail osteosynthesis group.Results:In the LCP group, the outcomes were excellent for 35.7% of the patients; good, 38.9%; satisfactory, 19.7%; and poor, 5.7%. In the C-Nail group, the outcomes were excellent for 36.9% of the patients; good; 31.6%; satisfactory, 21%; and poor, 10.2%. The mean values of the restoration of Böhler's angle from post-injury were 6.8° to 32.3° in the LCP group and 7.1° to 33.3° in the C-Nail group. After 12 months, there was only a minimal decrease in Böhler's angle to 29.2° in both the LCP and C-Nail groups.Conclusion:The outcomes obtained with C-Nail fixation are statistically identical to those obtained with LCP fixation. We conclude that osteosynthesis with a C-Nail is suitable as the first-choice treatment for Sanders types II and III fractures. Level of evidence IV, retrospective observational study.

C-Nail versus plate osteosynthesis in displaced intra-articular calcaneal fractures—a comparative retrospective study

“…However, not all wound edge necroses or superficial wound infections were subject to revision, many of them could be successfully treated by conservative wound management. It is also notable that the early-postoperative complication rate in the C-Nail group shown in our study—although lower than in the plate group—is nevertheless higher than described in other C-Nail-studies [ 1 , 16 , 24 ]. One explanation may be the higher number of complex fractures, including Sanders IV fractures with often primarily critical soft tissues.…”

“…To date, there have been only few clinical studies on the use of the C-Nail® [ 1 , 16 , 24 ]. So far, only one study by Zeman et al [ 1 ] compared the use of C-Nail® with the gold standard plate osteosynthesis via a lateral approach. Neither the rate of wound edge necrosis nor that of deep infections differs significantly between the groups in this study.…”

“…Zeman et al [ 1 ] achieved predominantly excellent and good results with both plate and C-Nail. Our patients achieved an average of 79.4 points at 6-month follow-up and thus good results, but our functional results are somewhat worse than the results of Zwipp et al [ 24 ] and Zeman et al [ 1 ]. However, we have treated significantly more Sanders IV fractures.…”

“…The surgical treatment of displaced intra-articular calcaneal fractures remains challenging. It aims at the most anatomic reduction possible while restoring joint congruence as well as height, length, and width of the calcaneus [ 1 – 3 ]. Thereby typical long-term consequences such as pain and weight-bearing insufficiency due to post-traumatic subtalar arthrosis up to subtalar arthrodesis shall be prevented or at least diminished [ 4 ].…”

“…The initial results are promising. To date, however, there have been only a few clinical studies on this new implant [ 1 , 16 , 24 ]. Randomized studies as well as long-term results are lacking.…”