Results After Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures

Abstract

Background: Operative treatment of calcaneal fractures using the extensile lateral approach is associated with high rates of soft tissue complications. In the past years, there has been a trend toward less invasive surgical approaches. Percutaneous and arthroscopically assisted calcaneal osteosynthesis (PACO) combines the advantages of visualization of the posterior facet of the subtalar joint with a minimally invasive approach. Methods: We conducted a follow-up of 25 patients with 26 calcaneal fractures (Sanders II and III), treated with PACO with a minimum follow-up of 12 months. The median age was 44 years (range, 21-72) and the follow-up period 15 months (12-33). Our clinical outcomes were the Manchester-Oxford Foot Questionnaire (MOxFQ), the Calcaneus Fracture Scoring System (CFSS), the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, the Short-Form-36 (SF-36), the visual analog scale (VAS) for pain, and the number of complications. Radiographs on follow-up were obtained to evaluate the reduction of the fractures as well as osteoarthritis of the subtalar joint. Results: The median MOxFQ score was 26.6 (0-76.6), the CFSS score 85 (26-100), and the AOFAS score 85 (50-100). The VAS pain score was 0 (0-5.7) at rest and 4.1 (0-8.2) during activity. The Böhler angle improved from a mean (SD) of 3.5 (12.3) degrees preoperatively to 27.7 (10.5) degrees postoperatively. The follow-up radiographs showed subsidence of the fractures and a Böhler angle of 20.3 (12.9) degrees. There were no wound-healing complications. Two patients had additional surgery with screw removal due to prominent hardware. Conclusion: Our results suggest that PACO gives good clinical outcomes and a low risk of complications in selected calcaneal fractures. Prospective long-term studies will be necessary to better document the potential advantages and limitations of this operating technique. Level of Evidence: Level IV, retrospective case series.

Minimally Invasive Surgery vs Nonoperative Treatment for Displaced Intraarticular Calcaneal Fracture: A Prospective Propensity Score Matched Cohort Study With 2-Year Follow-up

“…There is a notable lack of studies reporting the MOXFQ following calcaneal fracture surgery. Grün et al 15 reported a median MOXFQ Index score of 26.6 (0-76.6) following percutaneous and arthroscopically assisted calcaneal osteosynthesis that is greater than our study’s (28.6). Bremer et al 5 reported positive AOFAS scores (87 ± 13) at 24 months in their large series of displaced intraarticular calcaneal fractures that underwent operative fixation performed through a lateral subtalar approach.…”

Comparing small locking plate fixation versus small locking plate with screws fixation of displaced intra-articular calcaneus fracture via sinus tarsi approach

“…Previous studies have demonstrated that hollow screws have similar xation functions to the plates [17,18],Ni et al [19] described that adequate stability could be provided through the cross-screw technique,another study showed that longitudinal screw bear major stresses in standing position [20].Lv et al [21] described a double-point xation (DPF). Fixation of the posterior subtalar joint and calcaneal tuberculum can reduce the change in posterior articular surface displacement.Simon et al [22] achieved good results by xing DIACFs with a locking screw that xed the posterior subtalar joint and calcaneal tubercles.The above studies have demonstrated the reliability of DPF in xed subtalar joint and the good clinical results can be achieved, However, there are no systematic studies to guide the use of hollow screws,in order to provide better stability of the posterior articular surface and maintain the axial shape of the calcaneus, we recommend the use of hollow screw assisted plate xation in the case of severe calcaneal varus and posterior articular surface collapse.Protruding screws are an important reason for secondary surgery [23].In order to avoid screw irritation, the hollow screws should be embedded into the bone surface.…”

The Clinical Efficacy of Sustentaculum Tali Screws in Calcaneal Fractures

“…In recent years, some scholars have proposed the use of arthroscopic targeting devices or preoperative prefabricated templates to improve the accuracy of screw placement into the sustentaculum tail, but the actual clinical situation is limited by many factors and di cult to promote. 8,15,19,30 Theoretically, the sustentaculum tail can be placed through any point on the lateral wall of the calcaneus but where is the exact point of placement of sustentaculum tail screws and the direction of screw placement still cannot reach consensus as it is useful for clinical guidance. 5,13,18,24 In this study, we reviewed and analyzed surgical treatment cases of calcaneal fractures in our hospital, all of which were treated with accurate placement of the sustentaculum tail screws, and de ned the cases in which the sustentaculum tail screws passed through the rst continuous bone trabecula on the lateral side of the central triangle of the calcaneus but not from the range of the sustentaculum tail as the sustentaculum fragment xation group, and compared the clinical e cacy of accurate xation of the sustentaculum tail with that of the displaced intra-articular calcaneal fracture, and speci ed the speci c location of the nail placement in order to guide clinical practice.…”