Results After Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures

Foot Ankle Int. 2020 Jun;41(6):689-697. doi: 10.1177/1071100720914856. Epub 2020 May 15.

Abstract

Background: Operative treatment of calcaneal fractures using the extensile lateral approach is associated with high rates of soft tissue complications. In the past years, there has been a trend toward less invasive surgical approaches. Percutaneous and arthroscopically assisted calcaneal osteosynthesis (PACO) combines the advantages of visualization of the posterior facet of the subtalar joint with a minimally invasive approach.

Methods: We conducted a follow-up of 25 patients with 26 calcaneal fractures (Sanders II and III), treated with PACO with a minimum follow-up of 12 months. The median age was 44 years (range, 21-72) and the follow-up period 15 months (12-33). Our clinical outcomes were the Manchester-Oxford Foot Questionnaire (MOxFQ), the Calcaneus Fracture Scoring System (CFSS), the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, the Short-Form-36 (SF-36), the visual analog scale (VAS) for pain, and the number of complications. Radiographs on follow-up were obtained to evaluate the reduction of the fractures as well as osteoarthritis of the subtalar joint.

Results: The median MOxFQ score was 26.6 (0-76.6), the CFSS score 85 (26-100), and the AOFAS score 85 (50-100). The VAS pain score was 0 (0-5.7) at rest and 4.1 (0-8.2) during activity. The Böhler angle improved from a mean (SD) of 3.5 (12.3) degrees preoperatively to 27.7 (10.5) degrees postoperatively. The follow-up radiographs showed subsidence of the fractures and a Böhler angle of 20.3 (12.9) degrees. There were no wound-healing complications. Two patients had additional surgery with screw removal due to prominent hardware.

Conclusion: Our results suggest that PACO gives good clinical outcomes and a low risk of complications in selected calcaneal fractures. Prospective long-term studies will be necessary to better document the potential advantages and limitations of this operating technique.

Level of evidence: Level IV, retrospective case series.

Keywords: calcaneal fracture; percutaneous osteosynthesis; subtalar arthroscopy.

MeSH terms

  • Adult
  • Aged
  • Arthroscopy / methods*
  • Calcaneus / injuries*
  • Calcaneus / surgery*
  • Female
  • Fracture Fixation, Internal / methods*
  • Fractures, Bone / surgery*
  • Humans
  • Male
  • Middle Aged
  • Pain Measurement
  • Retrospective Studies
  • Surveys and Questionnaires
  • Young Adult