title: Percutaneous Reduction and Screw Fixation of Displaced Intra-articular Fractures of the Calcaneus.
abstract: BACKGROUND
  Extensile open approaches to reduce and fix intra-articular calcaneal fractures are associated with high levels of wound complications. To avoid these complications, a technique of percutaneous reduction and fixation with screws alone was developed. This study assessed the clinical outcomes, radiographs, and postoperative CT scans after operative treatment with this technique.
  
  
  METHODS
  153 consecutive patients with 182 intra-articular calcaneal fractures were reviewed. All patients were assessed for early postoperative complications at 3 months from the injury. The clinical results were assessed for patients seen at a minimum of 1 year after surgery (mean follow-up of 2.6 years; 90 patients, 106 feet). In patients who had both preoperative and postoperative CT scans (50 patients, 60 feet), the articular reduction was quantitatively analyzed.
  
  
  RESULTS
  At the 3-month follow-up, there were 1% superficial infections and 1% rate of screw irritation. The complications at a minimum of 1 year after injury included screw irritation 9.3%, subtalar osteoarthritis requiring subtalar fusion 5.5%, malunion 1.8%, and deep infection 0.9%. Bohler angle, calcaneal facet height, and width were significantly improved postoperatively ( P < .01). Bohler angle increased on average +24.1 degrees postoperatively with a loss of angle of 4.9 degrees at the 3-month follow-up. There was significant improvement ( P < .01) in posterior talocalcaneal joint reduction on postoperative CT scan but residual displacement remained. At the final follow-up, 54.5% of the patients reported a residual pain level of 3 or lower.
  
  
  CONCLUSIONS
  This study suggests that reasonable early results could be achieved from the percutaneous treatment of intra-articular calcaneal fractures using screws alone based on articular reduction and level of residual pain.
  
  
  METHODS
  Level IV, retrospective case series.
authors.affiliation: 1 Department of Orthopaedics, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Saran
authors.initials: S
authors.lastname: Tantavisut
authors.affiliation: 2 Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Phinit
authors.initials: P
authors.lastname: Phisitkul
authors.affiliation: 2 Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Brian O
authors.initials: BO
authors.lastname: Westerlind
authors.affiliation: 2 Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Yubo
authors.initials: Y
authors.lastname: Gao
authors.affiliation: 2 Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Karam
authors.affiliation: 2 Department of Orthopaedics, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
authors.forename: John L
authors.initials: JL
authors.lastname: Marsh
mesh_terms: D001174:Arthrodesis / Q000379:methods*; D002111:Calcaneus / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000473:pathology / Q000601:surgery*; D006801:Humans; D057072:Intra-Articular Fractures / Q000601:surgery*; D011183:Postoperative Complications; D011184:Postoperative Period; D011859:Radiography; D012189:Retrospective Studies; D013380:Subtalar Joint / Q000601:surgery*; D014057:Tomography, X-Ray Computed
keywords: intra-articular calcaneal fracture; percutaneous fixation; percutaneous reduction; screw fixation