title: Cohort study on the percutaneous treatment of displaced intra-articular fractures of the calcaneus.
abstract: BACKGROUND
  To reduce the high rate of soft tissue complications in the treatment of displaced intra-articular fractures of the calcaneus, several minimally invasive techniques have been developed. Little evidence exists on the clinical outcome of these techniques.
  
  
  METHODS
  We performed a study on a cohort of 46 fractures treated by the 3-point distraction technique. In 41 fractures, clinical outcome was available. Fractures were classified according to the Essex-Lopresti and Sanders classifications. The clinical outcome was determined using the 3 most frequently used outcome scores.
  
  
  RESULTS
  The clinical outcome of our cohort of percutaneous treated intra-articular calcaneal fractures was good to excellent in 69% with the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale (AOFAS) score. This percentage increases to 100% for tongue type fractures alone but decreases to 52% for joint depression type fractures. Infectious complications occurred in 1 (2.4%) and secondary arthrodesis was needed in 3 fractures (7.3%). The Sanders classification showed no prognostic value. The Essex-Lopresti classification was a strong prognosticator with a median AOFAS score of 92 (interquartile range [IQR], 87.8-97.8) for tongue type fractures and 75 (IQR, 63.0-85.0) for joint depression type fractures (P < .001).
  
  
  CONCLUSIONS
  The treatment of displaced intra-articular calcaneal fractures by the 3-point distraction technique was an acceptable alternative to open surgery and other percutaneous techniques. It had a low amount of infectious complications with comparable outcome to open treatment. The computed tomography-based Essex-Lopresti classification had a strong prognostic value when fractures were treated by the 3-point distraction technique. The results of this study support the use of the 3-point distraction technique, especially in tongue type fractures.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: Department of Surgery, Green Heart Hospital, Gouda, the Netherlands.
authors.forename: Stefan W
authors.initials: SW
authors.lastname: de Vroome
authors.forename: Frits M
authors.initials: FM
authors.lastname: van der Linden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002111:Calcaneus / Q000293:injuries* / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D057072:Intra-Articular Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
keywords: 3-point; calcaneus; cohort; distraction; trauma