C-Nail versus plate osteosynthesis in displaced intra-articular calcaneal fractures—a comparative retrospective study

Abstract

Background Locking plate osteosynthesis via an L-shaped lateral approach is the gold standard in treating displaced intra-articular calcaneal fractures. High complication rates are known for this approach. The most frequent complications are wound edge necrosis and superficial wound infections. To reduce complication rates, a locking intramedullary nail (C-Nail) was developed that can be implanted minimally invasively via a sinus tarsi approach. We compared the postoperative complication rate and the outcome of plate osteosynthesis versus C-Nail in displaced intra-articular calcaneal fractures. Methods All patients with calcaneal fractures who received osteosynthesis with either plate or C-Nail between January 2016 and October 2019 in our institution were retrospectively analyzed. A subgroup analysis was performed with matched pairs (matching Sanders type, age, Böhler’s angle postoperative in normal range, 33 pairs). Endpoints were postoperative complication rate, bone healing, full weight-bearing and functional outcome. Treatment groups were compared using Fisher’s exact test for binary data, and Mann-Whitney U-test for continuous data. A p-value < 0.05 was considered statistically significant. Results One hundred and one calcaneal fractures were included (C-Nail n = 52, plate n = 49). Patients with C-Nail developed significantly less postoperative complications (p = 0.008), especially wound edge necrosis (p < 0.001). Screw malposition was found more often in the C-Nail group. The rates of achieving full weight-bearing as well as bone healing were comparable in both groups, but in each case significant faster in the C-nail subgroup. The results of the matched-pairs analysis were comparable. Conclusions The postoperative complication rate was significantly lower in the C-Nail group. The C-Nail appears to be a successful alternative in the treatment of calcaneal fractures, even in Sanders IV fractures because of the minimal-invasive implantation as well as the high primary stability. Long-term analysis of this new implant including elaboration on functional outcome is planned. Trial registration Deutsches Register Klinischer Studien (DRKS) DRKS00020395. Date of registration 3 January 2020.

Comparison between intramedullary nail and conventional plate for displaced intra-articular calcaneal fractures: A meta-analysis

“…Three studies reported the length of hospital stay. [ 15 , 16 , 18 ] Pooled results showed that intramedullary nail had a reduced length of hospital stay compared to plate (MD: –3.65 days; 95% CI: –4.35, –2.95; p<0.00001) without significant heterogeneity (p=0.85, I 2 =0%, Figure 3).…”

Global research trends and hotspots in calcaneal fracture: A bibliometric analysis (2000–2021)

“…A finite -element analysis showed that the modified C-nail system can provide comparatively sufficient stability, making it preferable for the treatment of complex calcaneal fracture (36). A comparative retrospective study reported that the C-nail may be a successful alternative in the treatment of calcaneal fracture because of the minimally invasive implantation and high primary stability (37). The outcomes obtained with C-nail fixation are statistically identical to those obtained with locking calcaneal plate (LCP) fixation.…”

Calcaneous interlocking nail treatment for calcaneous fracture: a multiple center retrospective study

“…Wound problems were observed in 15 (28.6%) patients (Z = 3.689, P < 0.001). Eva Steinhausen [ 31 ] reported that 33 patients calcaneous fractures treated with C-nail fixation, the AOFAS average score were 80 ± 17 (t= -5.805 P < 0.001). Wound problems were observed in 15 (28.6%) patients (Z = 2.116, P = 0.0034).…”