Percutaneous and Arthroscopically Assisted Osteosynthesis for Calcaneal Fractures with Displacement of Different Calcaneal Talar Facet: A Retrospective Study

Abstract

Background: Percutaneous and Arthroscopically Assisted Osteosynthesis (PAAO) offers a successful treatment option for displaced intra-articular calcaneal fractures (DIACFs) due to its visibility and minimal invasiveness. However, the fixation method of PAAO is reported as unstable. It can result in postoperative collapse and unsatisfactory reduction. As DIACFs are associated with displacement of the calcaneal talar facet (CTF), the study aimed to investigate whether there is a difference in the efficacy of PAAO in the treatment of DIACFs with different CTF. It can provide guidance and help for the clinic. Methods: A total of 107 cases treated with PAAO were included in this study, and they were classified by CTF. Preoperative radiological parameters were collected, including the Bohler angle and calcaneal height, as well as patient-reported results, including the American Orthopedic Foot and Ankle Society (AOFAS) scores and Visual Analog Scale (VAS) scores. Results after surgery were analyzed and compared between different types of CTF. Results: Based on the CTF, DIACFs were divided into five groups ( 37 Type I, 25 Type II, 18 Type III, 16 Type IV, and 11 Type V). At the last follow-up, the Bohler angle of Type V (32.26 degrees) was larger than that of Type I, II, III, and IV (27.77, 27.99, 25.46 and 27.76 degrees), and calcaneal height of Type III (41.65 mm) was lower than that of Type V (48.22 mm)(all P < 0.05). There was no significant difference in AOFAS scores of five types (all P > 0.05). VAS scores were significantly higher in Type III (3.0) than Type I (2.1) and Type V (1.8)(all P < 0.05). Conclusions: PAAO showed good imaging and clinical results in DIACFs in short-term follow-up and the treatment effect varied from different types of CTF. Therefore, when it comes to DIACFs of CTF V, PAAO can be given priority, but for DIACFs of CTF III, it should be carefully considered whether to use this method.