Minimally invasive percutaneous osteosynthesis versus ORIF for Sanders type II and III calcaneal fractures: a prospective, randomized intervention trial

Abstract

BackgroundThis randomized controlled trial compared the clinical outcomes and complications of a novel minimally invasive percutaneous osteosynthesis (MIPO) with those of conventional treatment via an extended L-shaped lateral approach for calcaneal fractures.MethodsSixty-four patients with displaced intraarticular calcaneal fractures were enrolled. The patients were randomly allocated to receive either MIPO (29 patients) or open reduction and internal fixation via an extended L-shaped lateral approach (35 patients). The same calcaneal plate (AO Synthes, Oberdorf, Switzerland) was used in both groups. The primary clinical outcomes included operative time, VAS postoperatively, and wound healing complications. Secondary clinical outcomes included time to operation, length of incision, postoperative drainage, length of hospital stay, medical expense, AOFAS score, and SF-36 score. Preoperative and postoperative calcaneal height, width, and length, Bohler’s angle, and Gissane’s angle were compared.ResultsThe operative time in the MIPO group was 52.5 ± 11.1 min, which was significantly shorter than 82.8 ± 16.2 min in the conventional treatment group (P < 0.001). One week postoperatively, the VAS value was 3.2 ± 1.4 in the MIPO group, which was lower than that in the conventional treatment group, 3.9 ± 1.3 (P = 0.038). In the conventional treatment group, 13 of 35 fractures (37.1%) had wound healing problems, whereas this issue occurred in only 2 of 29 fractures (6.7%) in the MIPO group (P = 0.004). In the MIPO group, deep and superficial infections occurred in none of the cases and 1 of 29 (3.4%) patients, respectively. Length of incision in the MIPO group was shorter than that in the conventional treatment group (4.2 ± 0.6 vs. 10.9 ± 1.5 cm; P < 0.001). Hospital stay was 9.7 ± 2.8 days in the MIPO group and 11.7 ± 2.6 days in the conventional treatment group (P = 0.004). At the last follow-up, the SF-36 scores and AOFAS scores in the two groups were comparable (P > 0.05). The postoperative radiographic data, the Bohler’s angle, Gissane’s angle, and calcaneal height, width, and length in the two groups were comparable (P > 0.05).ConclusionsCompared with conventional ORIF, the advantages of MIPO are a considerably shortened operating time and hospital stay, decreased postoperative pain, and reduced risk of wound healing complications.

Short-Term Outcomes of Open Reduction and Internal Fixation for Sanders Type III Calcaneal Fractures With and Without Bone Grafts

“…Currently, open reduction and internal fixation (ORIF) is considered the reference standard treatment of displaced intraarticular fractures of the calcaneus (9,10), because anatomic reduction is important for feet and ankles to have functional outcomes. Also, ORIF is the best method for achieving calcaneal morphology restoration and anatomic reduction of the articular surface (11,12).…”

Comparing open reduction and internal fixation versus closed reduction using dual-point distraction and percutaneous fixation for treating calcaneal fractures

“…Many studies have compared the extended lateral approach and minimally invasive techniques to minimize the wound complication rate. [22][23][24][25] Most commonly, the sinus tarsi approach was used because it provides a direct exposure of the posterior facet. Kline et al [22] reported an overall wound complication rate of 6% in patients treated using the minimally invasive sinus tarsi approach.…”

Displaced Intra-articular Calcaneal Fractures: Classification and Treatment

“…The primary concern with this approach is a high complication rate. [36][37][38][39][40][41][42][43] Some techniques can be employed to decrease the risk of complications related to this approach. For example, the corner of the incision should be curved to avoid significant wound complications.…”

“…Wound complication rates have been reported to range from 0% to 15.4% with the sinus tarsi approach, 42,65 being lower than those reported for the extended lateral approach (range, 10% to 37.1%). 36,[41][42][43]67 Kline et al 48 performed a retrospective review to compare the outcomes of displaced intra-articular calcaneal fractures treated with ORIF via an extensile approach vs a minimally invasive sinus tarsi approach. Clinical results were similar for the 2 approaches, but the minimally invasive approach had a significantly lower incidence of wound complications and secondary surgeries.…”