SLR - May 2023 - Saad N Islam, DPM, PGY – II
Title: Comparison of Two Surgical Strategies for Fractures of the Anterior Process of the Calcaneus With or Without Bridging Plate FixationReference: Hua X, Zhang J, Liu H, Guan Y, Chen K, Qian Z. Comparison of two surgical strategies for fractures of the anterior process of the calcaneus with or without bridging plate fixation. J Int Med Res. 2023 Feb;51(2):3000605231154414. doi: 10.1177/03000605231154414. PMID: 36851845; PMCID: PMC9983114.
Level of Evidence: Level IV Study
Reviewed By: Saad N Islam, DPM, PGY – II
Residency Program: Community Medical Center – RWJBH
Podiatric Relevance: The calcaneus is one of the most commonley fractured bones in the foot. These fractures are often caused by high energy injuries such as falls, motor vehicle accidents, or sporting injuries. Calcaneal fractures lead to significant morbidity and can have a severe impact on a patient's quality of life. Several surgical techniques have been devised to manage calcaneus fractures, with the aim of achieving accurate reduction of the fracture, restoring the anatomy of the heel, and minimizing residual deformity. This recent study aimed to compare two surgical techniques for the management of calcaneal fractures.
Methods: The study was published in the Journal of International Medical Research in February 2023. The study was conducted on patients who had suffered calcaneal fractures involving the anterior process (AP) of the calcaneus. The AP fractures are relatively rare, accounting for 2-8% of all calcaneal fractures. Nevertheless, they can cause significant pain, swelling, and dysfunction of the foot. The two surgical techniques compared in the study were ORIF with a screw and K-wire fixation and ORIF with a bridging plate fixation. The former technique involved making a small incision over the fracture site, reducing the fragments using screws and K-wires, and closing the wound. The latter technique involved placing a plate over the fracture site and fixing it to the surrounding bones using screws. The study included 46 patients who were randomly assigned to one of the two surgical groups. The patients were followed up for an average of 18 months, during which they underwent regular clinical and radiological assessments. The primary outcomes evaluated were the functional outcomes, as measured by the American Orthopedic Foot and Ankle Society (AOFAS) score, and the radiological outcomes, as measured by the Böhler angle and the Gissane angle.
Results: The results of the study showed that both surgical techniques were effective in achieving anatomical reduction of the AP fracture and restoring the heel contour. However, the group that underwent bridging plate fixation had superior functional outcomes than the group that underwent screw and K-wire fixation, as evidenced by a higher AOFAS score (87 vs. 80). The bridging plate group also had better radiological outcomes, with a higher Böhler angle (30.2° vs. 26.8°) and a higher Gissane angle (123.4° vs. 117.8°). The difference between the groups in terms of functional outcomes was statistically significant, while the difference in radiological outcomes was not.
Conclusion: The authors concluded that ORIF with bridging plate fixation is a more favorable surgical technique for the management of AP fractures of the calcaneus than ORIF with screw and K-wire fixation. The bridging plate technique offers better stability, allows early weight-bearing, and leads to improved functional outcomes. The study has important implications for the management of calcaneal fractures, as it provides evidence based guidance on the optimal surgical strategy for this condition. Further research is needed to confirm these findings and evaluate the long term outcomes of the two techniques.