Percutaneous treatment of displaced intra-articular calcaneal fractures.
BACKGROUND
The outcome after displaced intra-articular calcaneal fractures is influenced by the condition of the surrounding soft tissues. To avoid secondary soft tissue complications after surgical treatment, several less-invasive procedures for reduction and fixation have been introduced. The percutaneous technique according to Forgon and Zadravecz is suitable for all types of displaced intra-articular calcaneal fractures and was therefore introduced in our clinic. The aim of this study was to evaluate the long-term outcome of percutaneous treatment according to Forgon and Zadravecz in patients with displaced intra-articular calcaneal fractures.


METHODS
A cohort of patients with displaced intra-articular calcaneal fractures treated with percutaneous surgery was retrospectively defined. Clinical outcome was evaluated by standardized physical examination, radiographs, three published outcome scores, and a visual analogue scale of patient satisfaction.


RESULTS
Fifty patients with 61 calcaneal fractures were included. After a mean follow-up period of 35 months, the mean values of the Maryland foot score, the Creighton-Nebraska score, and the American Orthopaedic Foot and Ankle Society score were 79, 76, and 83 points out of 100, respectively. The average visual analogue scale was 7.2 points out of 10. The average range of motion of the ankle joint was 90% of normal and subtalar joint movements were almost 70% compared with the healthy side or normal values. Superficial wound complications occurred in seven cases (11%) and deep infections in two (3%). A secondary arthrodesis of the subtalar joint was performed in five patients and was scheduled in four patients (15%).


CONCLUSIONS
Compared with the outcome of historic controls from randomized trials and meta-analyses, this study indicates favorable results for the percutaneous technique compared with the open technique. Despite similar rates of postoperative infection and secondary arthrodesis, the total outcome scores and preserved subtalar motion are overall good to excellent.
Schepers
Tim
T
Department of Surgery, Traumatology, Erasmus MC University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
Schipper
Inger B
IB
Vogels
Lucas M M
LM
Ginai
Abida Z
AZ
Mulder
Paul G H
PG
Heetveld
Martin J
MJ
Patka
Peter
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D001174:Arthrodesis / Q000379:methods; D001863:Bone Screws; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012086:Reoperation; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D015599:Trauma Severity Indices; D016896:Treatment Outcome