Journal of Korean Foot and Ankle Society (대한족부족관절학회지)

Korean Foot & Ankle Society (대한족부족관절학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical Results of Surgical Treatment with Minimally Invasive Percutaneous Plate Osteosynthesis for Displaced Intra-articular Fractures of Calcaneus

최소침습적 금속판 내고정술을 이용한 전위된 관절 내 종골 골절의 임상적 치료결과

  • Suh, Jae Wan (Department of Orthopedic Surgery, Dankook University College of Medicine) ;
  • Yang, Jong Heon (Department of Orthopedic Surgery, Dankook University College of Medicine) ;
  • Park, Hyun-Woo (Department of Orthopedic Surgery, Dankook University College of Medicine)
  • 서재완 (단국대학교 의과대학 정형외과학교실) ;
  • 양종헌 (단국대학교 의과대학 정형외과학교실) ;
  • 박현우 (단국대학교 의과대학 정형외과학교실)
  • Received : 2020.04.20
  • Accepted : 2020.05.08
  • Published : 2020.06.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study evaluated the clinical results of surgical treatment with minimally invasive plate osteosynthesis for treating displaced intra-articular fractures of the calcaneus in comparison with conventional lateral extensile approach plate osteosynthesis. Materials and Methods: Of 79 cases of Sanders type II or III calcaneus fractures, 15 cases treated with the minimally invasive calcaneal plate (group M) and 64 cases treated with lateral extensile approach calcaneal plate (group E) were identified. After successful propensity score matching considering age, sex, diabetes mellitus history, and Sanders type (1:3 ratio), 15 cases (group M) and 45 cases (group E) were matched and the demographic, radiologic, and clinical outcomes were compared between the two groups. Results: The median time of surgery from injury was 2.0 days in group M and 6.0 days in group E (p=0.014). At the six months follow-up, group M showed results comparable with those of group E in radiographic outcomes. In the clinical outcomes, group M showed better postoperative American Orthopaedic Foot and Ankle Society (AOFAS) and visual analogue scale (VAS) scores than did group E (p=0.001, p=0.008). A greater range of subtalar motion was achieved at the six months follow-up in group M (inversion 20.0° vs. 10.0°, p=0.002; eversion 10.0° vs. 5.0°, p=0.025). Although there were no significant differences in complications between the two groups (1 [6.7%] vs. 7 [15.6%], group M vs. group E; p=0.661), there was only one sural nerve injury and no wound dehiscence and deep infection in group M. Conclusion: Minimally invasive plate osteosynthesis showed superior clinical outcomes compared with that of the conventional lateral extensile approach plate osteosynthesis in Sanders type II or III calcaneus fractures. We suggest applying minimally invasive plate osteosynthesis in Sanders type II or III calcaneus fractures.

Keywords

References

  1. Letournel E. Open treatment of acute calcaneal fractures. Clin Orthop Relat Res. 1993;(290):60-7.
  2. Sanders R, Fortin P, DiPasquale T, Walling A. Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification. Clin Orthop Relat Res. 1993;(290):87-95.
  3. Howard JL, Buckley R, McCormack R, Pate G, Leighton R, Petrie D, et al. Complications following management of displaced intra-articular calcaneal fractures: a prospective randomized trial comparing open reduction internal fixation with nonoperative management. J Orthop Trauma. 2003;17:241-9. doi: 10.1097/00005131-200304000-00001.
  4. Mehta CR, An VVG, Phan K, Sivakumar B, Kanawati AJ, Suthersan M. Extensile lateral versus sinus tarsi approach for displaced, intraarticular calcaneal fractures: a meta-analysis. J Orthop Surg Res. 2018;13:243. doi: 10.1186/s13018-018-0943-6.
  5. Hsu AR, Anderson RB, Cohen BE. Advances in surgical management of intra-articular calcaneus fractures. J Am Acad Orthop Surg. 2015;23:399-407. doi: 10.5435/JAAOS-D-14-00287.
  6. Jin C, Weng D, Yang W, He W, Liang W, Qian Y. Minimally invasive percutaneous osteosynthesis versus ORIF for Sanders type II and III calcaneal fractures: a prospective, randomized intervention trial. J Orthop Surg Res. 2017;12:10. doi: 10.1186/s13018-017-0511-5.
  7. Lamichhane A, Mahara D. Management of intra-articular fracture of calcaneus by combined percutaneous and minimal internal fixation. J Nepal Health Res Counc. 2013;11:70-5.
  8. Xia S, Wang X, Lu Y, Wang H, Wu Z, Wang Z. A minimally invasive sinus tarsi approach with percutaneous plate and screw fixation for intra-articular calcaneal fractures. Int J Surg. 2013;11:1087-91. doi: 10.1016/j.ijsu.2013.09.017.
  9. Randolph JJ, Falbe K, Manuel AK, Balloun JL. A step-by-step guide to propensity score matching in R. Pract Assess Res Eval. 2014;19:1-6. doi: 10.7275/n3pv-tx27.
  10. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika. 1983;70:41-55. doi: 10.1093/biomet/70.1.41.
  11. Benirschke SK, Sangeorzan BJ. Extensive intraarticular fractures of the foot. Surgical management of calcaneal fractures. Clin Orthop Relat Res. 1993;(292):128-34.
  12. Yeo JH, Cho HJ, Lee KB. Comparison of two surgical approaches for displaced intra-articular calcaneal fractures: sinus tarsi versus extensile lateral approach. BMC Musculoskelet Disord. 2015;16:63. doi: 10.1186/s12891-015-0519-0.
  13. Rammelt S, Amlang M, Barthel S, Gavlik JM, Zwipp H. Percutaneous treatment of less severe intraarticular calcaneal fractures. Clin Orthop Relat Res. 2010;468:983-90. doi: 10.1007/s11999-009-0964-x.
  14. Hospodar P, Guzman C, Johnson P, Uhl R. Treatment of displaced calcaneus fractures using a minimally invasive sinus tarsi approach. Orthopedics. 2008;31:1112. doi: 10.3928/01477447-20081101-08.
  15. Abdelgaid SM. Closed reduction and percutaneous cannulated screws fixation of displaced intra-articular calcaneus fractures. Foot Ankle Surg. 2012;18:164-79. doi: 10.1016/j.fas.2011.07.005.
  16. Gotha HE, Zide JR. Current controversies in management of calcaneus fractures. Orthop Clin North Am. 2017;48:91-103. doi: 10.1016/j.ocl.2016.08.005.
  17. Seat A, Seat C. Lateral extensile approach versus minimal incision approach for open reduction and internal fixation of displaced intraarticular calcaneal fractures: a meta-analysis. J Foot Ankle Surg. 2020;59:356-66. doi: 10.1053/j.jfas.2019.08.007.
  18. Buckley R, Tough S, McCormack R, Pate G, Leighton R, Petrie D, et al. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2002;84:1733-44. doi: 10.2106/00004623-200210000-00001.
  19. DeWall M, Henderson CE, McKinley TO, Phelps T, Dolan L, Marsh JL. Percutaneous reduction and fixation of displaced intra-articular calcaneus fractures. J Orthop Trauma. 2010;24:466-72. doi: 10.1097/BOT.0b013e3181defd74.
  20. Weber M, Lehmann O, Sagesser D, Krause F. Limited open reduction and internal fixation of displaced intra-articular fractures of the calcaneum. J Bone Joint Surg Br. 2008;90:1608-16. doi: 10.1302/0301-620X.90B12.20638.