Cannulated screw fixation versus plate fixation in treating displaced intra-articular calcaneus fractures: a systematic review and meta-analysis

Postoperative complications after displaced intra-articular calcaneal fracture operations

BACKGROUND

The objective was to compare postoperative complications in the management of displaced intra articular calcaneal fractures (DIACF) between two groups; the open reduction and internal fixation (ORIF) group versus the percutaneous fixation (PF) group.

METHODS

A total of 243 DIACFs were diagnosed and 127 of them received operations either with ORIF 75 (59.1 %) or PF 52 (40.9 %) between 2004 and 2018. Postoperative complications, radiological Sanders's classification and improvement of Böhler's angle were analyzed.

RESULTS

Early complication rate (<6 weeks), rate of deep wound infections and wound edge necrosis were significantly better in PF than in ORIF patient group. There were no significant differences in late complications (>6 weeks from operation) nor in improvement of Böhler's angle.

CONCLUSION

Complication rate is lower when using PF technique while fracture reduction remains the same compared to the ORIF.

LEVEL OF EVIDENCE

IV retrospective cohort study at a single institution.

Emergency definitive management of a subtalar dislocation with an associated lateral malleolus fracture

Lateral subtalar dislocations are rare injuries with the potential for misdiagnosis and for poor patient outcomes if missed. Prompt reduction and surgical intervention is the consensus and is key to improved patient outcomes.We present a case of a male patient in his 70s who was brought in by ambulance to the emergency department late one afternoon with a lateral subtalar dislocation associated with calcaneal and lateral malleolar fractures. He was operated on that evening, involving cannulated screw fixation of the calcaneus and buttress plating of the lateral malleolus. Non-weight-bearing mobilisation was permitted at 2 weeks and weight-bearing was commenced at 6 weeks postoperatively.The authors could not find any precedent in the literature for same-day definitive fixation and early mobilisation of this rare but significant injury, the combination of which resulted in excellent functional outcomes for the patient.

Implant Choice and Outcomes of the Sinus Tarsi Approach for Displaced Intra-articular Calcaneal Fractures

BACKGROUND

Operative fixation of displaced intra-articular calcaneal fractures is considered the gold standard, for which multiple fixation methods are available. This study compares the (functional) outcome of screw fixation (SF), plate fixation (PF), and anatomical plate fixation (APF) via the sinus tarsi approach (STA).

METHODS

A total of 239 patients (265 fractured calcanei) who received surgical treatment of a displaced intra-articular calcaneal fracture via STA between 2011 and 2022 were included.

RESULTS

Böhler angle (BA) measured immediately postoperatively (BA post-OR) and the decrease in BA at 1 year (∆BA) differed significantly in favor of PF/APF compared with SF (BA post-OR: SF vs PF P = .010 and SF vs APF P = .001; ∆BA: SF vs PF P = .032 and SF vs APF P = .042). Implant removal surgery was performed significantly less in the APF group as compared to the SF/PF groups (APF vs SF/PF; 9.9% vs 22.9%/23.7%, P = .015). Surgical site infections and secondary arthrodesis of the subtalar joint occurred equally in the 3 groups. Furthermore, the mean American Orthopaedic Foot & Ankle Society ankle-hindfoot scale, Foot Function Index score, and EuroQOL-5D-index / visual analog scale score, did not differ notably between SF, PF, and APF.

CONCLUSION

The results show that both PF and APF are favored over SF because of an improved correction of BA measured directly postoperatively, a lower secondary loss of BA and, for APF, a lower implant removal rate. There was no difference in the rate of surgical site infections, need for secondary arthrodesis, nor functional outcome scores between different implants using the STA.

LEVEL OF EVIDENCE

Level III, retrospective cohort study.