SLR - November 2023 - Ng
Title: Percutaneous fixation of displaced intraarticular fractures of the calcaneus. A retrospective case series study and a review of the literatureReference: Chaniotakis C, Genetzakis V, Samartzidis K, Siligardou MR, Stavrakakis I. Percutaneous fixation of displaced intraarticular fractures of the calcaneus. A retrospective case series study and a review of the literature. Injury. 2023 Oct;54(10):110966. doi: 10.1016/j.injury.2023.110966. Epub 2023 Jul 27. PMID: 37549534.
Level of Evidence: III
Reviewed By: Jeffrey Ng PGY-2
Residency Program: New York College of Podiatric Medicine, New York NY
Podiatric Relevance: This study aims to assess the outcomes and complications in patients with displaced intra-articular calcaneal fractures (DIACFs) who underwent percutaneous fixation. Additionally, it seeks to explore and establish correlations between various influential factors affecting these outcomes as its secondary objective.
Methods: This single-center retrospective study involved 8 patients with Sander's type II and III injuries, with 6 patients having type II and 2 patients having type III injuries in Greece. The study had no specified exclusion criteria. Patients were divided into two sub-groups based on the time of treatment post-injury: one group received treatment in less than 6 days, and the other in more than 6 days. All 8 patients underwent closed reduction and percutaneous fixation using the Mattiassich and Rodemund technique. The study noted the presence of intra-articular displacement in the Broden view and calcaneal broadening in the Harris axial view. The follow-up period ranged from 6 to 12 months, with a mean of 9 months. The final follow-up included AOFAS (American Orthopedic Foot and Ankle Society) scores for analysis, considering the treatment time post-injury (6-day threshold) and post-operative Bohler's angle (>10 or <10 degrees). Complications, such as infection, wound healing problems, and post-op Bohler's angle deviations, were also analyzed.
Results: This study primarily focused on two quantitative measurements: AOFAS scores and post-operative Bohler's angles. The pre-operative AOFAS score averaged 84.6. Patients treated within 6 days of injury had AOFAS scores averaging 91.3, while those treated after 6 days had scores averaging 78. For patients with post-operative Bohler's angles >10 degrees, the AOFAS score averaged 92.5, compared to 76.8 for those with angles <10 degrees. Among the 8 patients, 4 reported post-operative complications. Two of the 4 patients with angles <10 degrees developed post-traumatic subtalar arthritis, and three of them experienced lateral heel pain. Notably, there were no complications among the 4 patients with post-op Bohler's angles >10 degrees. In summary, early treatment within 6 days post-injury and achieving post-op Bohler's angles >10 degrees were associated with significantly higher AOFAS scores. Importantly, there were no reports of infection or wound healing problems in any of the 8 patients treated using the percutaneous approach in this study.
Conclusions: The authors highlighted the safety and effectiveness of percutaneous fixation for intra-articular calcaneal fractures, emphasizing its lower wound complication and infection rates compared to open reduction internal fixation. They also stressed the importance of restoring Bohler's angle for favorable clinical outcomes, with the timing of surgery playing a crucial role. However, they suggested considering a sinus tarsi approach if percutaneous means cannot achieve anatomical reduction. The study has limitations, including a small sample size, single-center setting, short follow-up time, lack of demographic information, and arbitrary selection of study parameters. It provides opportunities to expand research parameters, such as conducting multi-center studies with longer follow-up periods, assessing interobserver reliability, and comparing various techniques. This could potentially redefine surgical timing and post-op quantitative findings thresholds in the field.