title: Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures: a prospective randomized controlled trial.
abstract: The management of displaced intra-articular calcaneal fractures (DIACFs) remains challenging and controversial. A prospective randomized controlled trial was conducted to compare percutaneous reduction, cannulated screw fixation and calcium sulfate cement (PR+CSC) grafting with minimally invasive sinus tarsi approach and plate fixation (MISTA) for treatment of DIACFs.
  
  
  
  Ultimately, 80 patients with a DIACFs were randomly allocated to receive either PR+CSC (N = 42) or MISTA (N = 38). Functional outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores. Radiological results were assessed using plain radiographs and computed tomography (CT) scans, and postoperative wound-related complications were also recorded.
  
  
  
  The average time from initial injury to operation and the average operation time in the PR+CSC group were both significantly shorter than those in the MISTA group (p < 0.05). There were significantly fewer complications in the PR+CSC group than those in the MISTA group (7.1 % vs 28.9 %, p < 0.001). The calcaneal width immediate postoperatively and at the final follow-up in the MISTA group were obviously improved compared to those in the PR+CSC group (p < 0.001). The variables of sagittal motion and hindfoot motion of the AOFAS scoring system in the PR+CSC group were significantly higher than those in the MISTA group (p < 0.05). The good and excellent results in the two groups were comparable for Sanders Type-II calcaneal fractures, but the good to excellent rate in the MISTA group was significantly higher for Sanders Type-III fractures (p < 0.05).
  
  
  
  The clinical outcomes are comparable between the two minimally invasive techniques in the treatment of Sanders Type-II DIACFs. The PR+CSC grafting is superior to the MISTA in terms of the average time between initial injury and operation, operation time, wound-related complications and subtalar joint activity. However, the MISTA has its own advantages in improving the calcaneal width, providing a more clear visualization and accurate reduction of the articular surface, especially for Sanders Type-III DIACFs.
  
  
  
  ChiCTRIOR16008512 . 21 May 2016.
authors.affiliation: Department of Orthopaedics Surgery, The Second Affiliated Hospital of Wenzhou Medical University, NO. 109, Xue Yuan West Road, Lucheng District, Wenzhou, Zhejiang Province, 325027, China.
authors.forename: Yongzeng
authors.initials: Y
authors.lastname: Feng
authors.affiliation: Department of Orthopaedics Surgery, The Second Affiliated Hospital of Wenzhou Medical University, NO. 109, Xue Yuan West Road, Lucheng District, Wenzhou, Zhejiang Province, 325027, China.
authors.forename: Xiaolong
authors.initials: X
authors.lastname: Shui
authors.affiliation: Department of Orthopaedics Surgery, The Second Affiliated Hospital of Wenzhou Medical University, NO. 109, Xue Yuan West Road, Lucheng District, Wenzhou, Zhejiang Province, 325027, China.
authors.forename: Jianshun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Orthopaedics Surgery, The Second Affiliated Hospital of Wenzhou Medical University, NO. 109, Xue Yuan West Road, Lucheng District, Wenzhou, Zhejiang Province, 325027, China.
authors.forename: Leyi
authors.initials: L
authors.lastname: Cai
authors.affiliation: Department of Orthopaedics Surgery, The Second Affiliated Hospital of Wenzhou Medical University, NO. 109, Xue Yuan West Road, Lucheng District, Wenzhou, Zhejiang Province, 325027, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Orthopaedics Surgery, The Second Affiliated Hospital of Wenzhou Medical University, NO. 109, Xue Yuan West Road, Lucheng District, Wenzhou, Zhejiang Province, 325027, China.
authors.forename: Xiaozhou
authors.initials: X
authors.lastname: Ying
authors.affiliation: Department of Orthopaedics Surgery, The Second Affiliated Hospital of Wenzhou Medical University, NO. 109, Xue Yuan West Road, Lucheng District, Wenzhou, Zhejiang Province, 325027, China.
authors.forename: Jianzhong
authors.initials: J
authors.lastname: Kong
authors.affiliation: Department of Orthopaedics Surgery, The Second Affiliated Hospital of Wenzhou Medical University, NO. 109, Xue Yuan West Road, Lucheng District, Wenzhou, Zhejiang Province, 325027, China. hongjianjun_fey@163.com.
authors.forename: Jianjun
authors.initials: J
authors.lastname: Hong
mesh_terms: D000328:Adult; D000368:Aged; D001843:Bone Cements / Q000627:therapeutic use*; D001860:Bone Plates; D001863:Bone Screws; D002111:Calcaneus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D002133:Calcium Sulfate / Q000627:therapeutic use*; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000601:surgery*; D006365:Heel / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D057072:Intra-Articular Fractures / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011859:Radiography; D016059:Range of Motion, Articular; D013380:Subtalar Joint / Q000502:physiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001843:Bone Cements; D002133:Calcium Sulfate
keywords: Calcaneus; Intra-articular fractures; Minimally invasive; Percutaneous fixation; Randomized controlled trial; Sinus tarsi approach