Is arthroscopic assisted percutaneous screw fixation as good as open reduction and internal fixation for the treatment of displaced intra-articular calcaneal fractures?

Yeap, Ewe Juan; Rao, Jaynesthra; Pan, Chee Huan; Soelar, Shahrul Aiman; Younger, Alastair

doi:10.1016/j.fas.2015.06.008

Cited by 34 publications

(27 citation statements)

References 37 publications

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“…It may be speculated, that many of those patients with simple Sanders Type 2 fractures could have been treated with percutaneous or less invasive methods that could have resulted in superior function and less soft-tissue complications. 55 56 57 58 59 Therefore, comparative trials should also include those patients with severe injuries.…”

Section: What Is the Current Evidence?mentioning

confidence: 99%

“…Minimally-invasive fixation of calcaneal fractures significantly reduces the risk of soft-tissue complications. 55 56 57 58 74 80 Many authors consider percutaneous reduction and screw fixation in cases of extraarticular and simple intraarticular fractures with the posterior facet being displaced as a whole as in Sanders Type IIC fractures. 55 81 These techniques can be extended to intraarticular fractures with only 1 displaced fracture line across the subtalar joint (i.e., Sanders Types IIA and IIB) with proper control of the articular reduction with subtalar arthroscopy or three-dimensional (3D) fluoroscopy.…”

Section: Choice Of Approachesmentioning

confidence: 99%

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Calcaneal Fractures — Should We or Should We not Operate?

Rammelt

Sangeorzan

Swords

2018

IJOO

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The best treatment for displaced, intraarticular fractures of the calcaneum remains controversial. Surgical treatment of these injuries is challenging and have a considerable learning curve. Studies comparing operative with nonoperative treatment including randomized trials and meta-analyses are fraught with a considerable number of confounders including highly variable fracture patterns, soft-tissue conditions, patient characteristics, surgeon experience, limited sensitivity of outcome measures, and rehabilitation protocols. It has become apparent that there is no single treatment that is suitable for all calcaneal fractures. Treatment should be tailored to the individual fracture pathoanatomy, accompanying soft-tissue damage, associated injuries, functional demand, and comorbidities of the patient. If operative treatment is chosen, reconstruction of the overall shape of the calcaneum and joint surfaces are of utmost importance to obtain a good functional result. Despite meticulous reconstruction, primary cartilage damage due to the impact at the time of injury may lead to posttraumatic subtalar arthritis. Even if subtalar fusion becomes necessary, patients benefit from primary anatomical reconstruction of the hindfoot geometry because in situ fusion is easier to perform and associated with better results than corrective fusion for hindfoot deformities in malunited calcaneal fractures. To minimize wound healing problems and stiffness due to scar formation after open reduction and internal fixation (ORIF) through extensile approaches several percutaneous and less invasive procedures through a direct approach over the sinus tarsi have successfully lowered the rates of infections and wound complications while ensuring exact anatomic reduction. There is evidence from multiple studies that malunited displaced calcaneal fractures result in painful arthritis and disabling, three-dimensional foot deformities for the affected patients. The poorest treatment results are reported after open surgical treatment that failed to achieve anatomic reconstruction of the calcaneum and its joints, thus combining the disadvantages of operative and nonoperative treatment. The crucial question, therefore, is not only whether to operate or not but also when and how to operate on calcaneal fractures if surgery is decided.

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Section: What Is the Current Evidence?mentioning

confidence: 99%

Section: Choice Of Approachesmentioning

confidence: 99%

Calcaneal Fractures — Should We or Should We not Operate?

Rammelt

Sangeorzan

Swords

2018

IJOO

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“…The patient groups were comparable except in three studies where they were significantly disproportionate. 16 , 18 , 25 …”

Section: Discussionmentioning

confidence: 99%

“… 13 , 27 The quality of reduction is debatable after minimally invasive techniques and the additional use of subtalar arthroscopy may assist in a better estimation of fracture reduction and potentially improving the overall outcomes. 23 , 25 …”

Section: Introductionmentioning

confidence: 99%

Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures

et al. 2018

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The aim of this article is to systematically identify and analyse research evidence available to compare the outcomes of minimally invasive reduction and percutaneous fixation (MIRPF) versus open reduction and internal fixation (ORIF) for displaced intra-articular calcaneal fractures.Articles from 2000 to 2016 were searched through MEDLINE (PubMed), Cochrane Library, Embase, ScienceDirect, Scopus and ISI Web of Knowledge using Boolean logic and text words. Of the 570 articles identified initially, nine were selected including three randomized controlled trials and six retrospective comparative studies.All nine studies had a total of 1031 patients with 1102 displaced intra-articular calcaneal fractures. Mean follow-up was 33 months. Of these, 602 (54.6%) were treated with MIRPF and 500 (45.4%) were treated with ORIF.Overall incidence of wound-related complications in patients treated with MIRPF was 4.3% (0% to 13%) compared with 21.2% (11.7% to 35%) in the ORIF groupFunctional outcomes were reported to be better in the minimally invasive group in all studies; however, the results did not reach statistical significance in some studies. All the studies had methodological flaws that put them at either ‘unclear’ or ‘high’ risk of bias for multiple domains.Overall quality of the available evidence is poor in support of either surgical technique due to small sample size, flaws in study designs and high risk of bias for various elements. Individual studies have reported minimally invasive techniques to be an effective alternative with lower risk of wound complications and better functional outcomes.Cite this article: EFORT Open Rev 2018;3:418-425. DOI: 10.1302/2058-5241.3.170043

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“…Choosing a non-operative treatment can avoid wound complications result in many late complications such as hindfoot malalignment, peroneal tendon dislocation, subtalar joint dysfunction and foot mechanics disruption [2].…”

mentioning

confidence: 99%

Is Wound Complication a Deterrent to Lateral Extensile Approach in Calcaneus Fracture?

Chin¹,

Ying²,

Izani³

2019

OJO

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Introduction: The lateral extensile approach has been a widely accepted surgical approach in treatment of intraarticular calcaneal fracture. It provides good exposure for fixation by correcting the hindfoot varus, fracture reduction and restores calcaneal height but it has a high wound complication rate. Methods and materials: 36 intraarticular calcaneal fractures (Sanders II, III and IV) treated using the lateral extensile approach in 34 patients presenting between 2015 and 2018 were retrospectively reviewed. Wound complication in the early stage (day 1 to day 3), intermediate (2 weeks) and late (6 weeks) were documented. Results: We found early (Day 1 -Day 3) infection rate of 5.6%, intermediate (2 weeks) at 17.6% and late wound complication (6 weeks) at 2.9%. Conclusion: Lateral expansile approach is a reliable surgical exposure for fracture reduction of calcaneal fractures with acceptable wound related complication rate. Minimally invasive techniques and the sinus tarsi approach are being used for less comminuted fractures, but those techniques are technically more demanding. Smoking, long duration of surgery and soft tissue handling also play a role in increasing wound complication rates.

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Is arthroscopic assisted percutaneous screw fixation as good as open reduction and internal fixation for the treatment of displaced intra-articular calcaneal fractures?

Cited by 34 publications

References 37 publications

Calcaneal Fractures — Should We or Should We not Operate?

Calcaneal Fractures — Should We or Should We not Operate?

Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures

Is Wound Complication a Deterrent to Lateral Extensile Approach in Calcaneus Fracture?

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