Comparison of Minimally Invasive Reduction Combined With Medial and External Fixation in the Treatment of Intra-articular Calcaneal Fractures

Abstract BackgroundComparison of percutaneous minimally invasive replacement joint inside external fixation technique and tarsal sinus approach to treat Sanders Ⅱ and Ⅲ clinical effect of intra-articular calcaneal fractures.MethodsThe clinical data of 64 cases of calcaneal fracture admitted to our hospital from January 2010 to January 2016 were retrospectively analyzed.According to different surgical methods,they were divided into the percutaneous minimally invasive reduction and internal and external fixation group (30 cases) and the tarsal sinus approach (34 cases).Comparison of two groups of patients with operation time,intraoperative blood loss,hospital stay, postoperative complications and radiographic evaluation including heel bone length,width,height,Bohler Angle,Angle of Gissane,calcaneal varus Angle,clinical efficacy evaluation including the American Orthopaedic Foot and Ankle Society (AOFAS),the visual analogue score for pain(VAS) score,health survey profiles (SF - 36) score and score Maryland ankle function.ResultsPatients in both groups were followed up for 12 to 50 months,an average of 24.8 months.All fractures obtained bone union.The waiting time,hospital stay,intraoperative blood loss and incision complications in the percutaneous minimally invasive medial and external fixation group were lower than those in the tarsal sinus group,and the differences were statistically significant (P<0.01).At the last follow-up,the length,width,height,Angle of Bohler,Angle of Gissane,and Angle of calcaneal varus were significantly increased in both groups (P<0.01),the calcaneal width was significantly lower than that before surgery (P<0.01),and the difference between the two groups was not statistically significant (P > 0.05).Clinical efficacy evaluation The AOFAS,VAS,SF-36 and Maryland scores were (85.28±8.21),(0.84±1.21),(82.95±3.25) and (83.56±3.32) at the last follow-up in the percutaneous minimally invasive medial and external fixation group.The AOFAS, VAS, SF-36 and Maryland scores of the tarsal sinus group were (83.32 ± 7.69),(1.85 ± 1.32),(80.71 ± 5.42),(81.85 ± 2.41) points,and there was no significant difference between the two groups (P > 0.05).ConclusionUnder the condition of having a good command of surgical indications and surgical skills,the use of calcaneoplastic forceps for percutaneous minimally invasive reduction combined with medial and external fixation for treatment of intra-articular calcaneoplasty fractures can achieve similar clinical effects as the tarsal sinus approach.However,the use of calcaneoplastic forceps for percutaneous minimally invasive reduction combined with internal and external fixation has advantages such as fewer complications, less blood loss,and shorter operation time,etc,which is of good safety and worthy of clinical promotion.