SLR- November 2022- Anas Siddiqi, DPM
Title: Articular calcaneal fractures: open or minimally invasive surgery, when the medial wall reduction is obtained percutaneously from the lateral sideReference: Xu H, Hou R, Ju J, Liu Y, Chen L. Articular calcaneal fractures: open or minimally invasive surgery, when the medial wall reduction is obtained percutaneously from the lateral side. Int Orthop. 2021 Sep;45(9):2365-2373. doi: 10.1007/s00264-021-05164-5. Epub 2021 Aug 1. PMID: 34333675.
Reviewed By: Anas Siddiqi, DPM
Residency Program: Beaumont Wayne, Wayne, MI
Level of Evidence: Level IV
Podiatric Relevance: Calcaneal fractures is a debilitating pathology that often requires surgical intervention. The ideal treatment of calcaneal fractures is still debatable with lateral extensile approach being the most common approach for treatment. The authors of this study suggest an alternative sinus tarsi approach with percutaneous medial reduction for treatment of calcaneal fractures. The purpose of this study was to compare the clinical outcomes of patients treated with surgery through lateral extensile approach (ELA) and sinus tarsi approach (STA) combined with a percutaneous medial reduction.
Methods: A retrospective chart review was performed for 96 patients who underwent repair of calcaneal fracture with 51 in the lateral extensile approach group and 45 in the sinus tarsi approach group between January 2016 and March 2021. Patients were excluded from the study if they were unable to follow-up with the senior author at the time of study. Patient demographics, radiographic angles, postoperative complications, failure rates, and patient-reported outcome scores were recorded. STA approach was performed with a 2–3-cm incision made from the tip of the fibula to the base of the fourth metatarsal with another lateral incision of about 1 cm was made for the insertion of a vessel forceps or a periosteal elevator which were used to percutaneously correct the deformity. STA approach was fixated using screws. ELA approach was performed using a L-shaped incision consisted of a vertical incision making from midway between the fibula and Achilles tendon and a horizontal incision in line with the base of the fifth metatarsal. A conventional locking plate was used for fixation in the ELA group.
Results: A total of 96 patients underwent surgical intervention for calcaneal fractures between January 2016 and March 2021. Data from 96 patients were available at follow-up. The total cohort average follow-up was 26.43 months. Pre-operatively the fractures were evaluated using the Sanders classification and was found to have no statistical differences between the two groups. Radiographic angels such as Bowlers angle, Glissane’s angle were evaluated pre and post-operatively and there was no statistical difference between the two groups for anatomical reduction of the fractures post-operatively. Only one patient had a superficial infection without skin necrosis in the STA group. Seven patients had partial skin flap necrosis and three had superficial infections in the ELA group. There was a statistical difference in the rate of total wound complications between the two groups (P=0.008). Three cases of sural nerve injuries were found in the ELA group, and two cases were found in the STA group. Average postoperative AOFAS Ankle-Hindfoot scores for ELA groups and STA group were 87.85 and 88.94 respectively.
Conclusion: In summary, STA with percutaneous medial reduction resulted in comparative radiological and clinical results with a shorter waiting time before surgery and fewer wound complications as compared to the ELA group. Screw fixation also appears to be a viable form of fixation versus the conventional locking plate.