title: Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures - a randomized controlled trial.
abstract: OBJECTIVE
  We aimed to compare the clinical outcomes of intra-articular calcaneus fractures treated with open reduction and internal fixation with conventional plate via L-shaped lateral approach (routine treatment) versus those with percutaneous plate via a sinus tarsi approach (minimally invasive treatment).
  
  
  METHODS
  One hundred and seventeen displaced intra-articular calcaneal fractures in 108 patients from January 2007 and September 2010 were randomly allocated to receive routine treatment (49 patients) or minimally invasive treatment (59 patients). Operative time, preoperative and postoperative calcaneal height, width, length, Böhlers angle, Gissanes angle, and incision healing were recorded. Maryland foot score system was used to evaluate clinical functional outcomes.
  
  
  RESULTS
  The operative time of minimally invasive group was significantly shorter than that of the routine group [46-80 min (mean, 62 min) vs 65-110 min (mean, 93 min), p < 0.01]. Postoperative X-ray showed the calcaneal height, width, length, Böhlers angle and Gissanes angle were significantly improved in both two groups, and no significant difference was observed between two groups postoperatively. No feet developed wound complications in minimally invasive group, but incision complications occurred in 8 feet in routine group. The excellent and good rate according to the Maryland foot score was significantly higher in minimally invasive group than that in the routine group (93.8% vs 86.8%).
  
  
  CONCLUSIONS
  Compared with L-shaped lateral approach treatment of displaced intra-articular calcaneal fractures, sinus tarsi approach for the reduction and internal fixation with percutaneous plate seems to be more safe and effective, with satisfactory clinical therapeutic effects and without postoperative complications.
authors.affiliation: Department of Orthopaedics, Zhoupu Hospital of Pudong, Shanghai 201318, China. Electronic address: victorxia@126.com.
authors.forename: Shengli
authors.initials: S
authors.lastname: Xia
authors.affiliation: Department of Orthopaedics, Zhoupu Hospital of Pudong, Shanghai 201318, China.
authors.forename: Yaogang
authors.initials: Y
authors.lastname: Lu
authors.affiliation: Department of Orthopaedics, Zhoupu Hospital of Pudong, Shanghai 201318, China.
authors.forename: Huizhong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics, Zhoupu Hospital of Pudong, Shanghai 201318, China.
authors.forename: Zuming
authors.initials: Z
authors.lastname: Wu
authors.affiliation: Department of Orthopaedics, Zhoupu Hospital of Pudong, Shanghai 201318, China.
authors.forename: Ziping
authors.initials: Z
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D064386:Ankle Fractures / Q000601:surgery*; D001860:Bone Plates; D002111:Calcaneus / Q000293:injuries*; D005260:Female; D005592:Fracture Fixation / Q000295:instrumentation* / Q000379:methods*; D005593:Fracture Fixation, Internal / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D061646:Operative Time; D016896:Treatment Outcome; D055815:Young Adult
keywords: Calcaneus; Intra-articular fractures; Open reduction and internal fixation; Percutaneous plate fixation; Sinus tarsi approach