Radiographic and Postoperative Outcomes of Plate Versus Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi

Abstract

Background: Intra-articular fractures of the calcaneus are a common injury to the hindfoot following high-energy trauma to the lower extremity. Treatment of these fractures has evolved. Due to the concern of wound complications associated with extensile open treatment, smaller incision techniques, such as the sinus tarsi approach, are increasing in popularity. A number of fixation strategies are utilized with this approach, and it is unknown which most accurately restores radiographic alignment. The purpose of this study was to compare the postoperative radiographic outcomes of a plate and screw construct versus a cannulated screw construct when using the sinus tarsi approach for open reduction and internal fixation (ORIF) of calcaneus fractures. Methods: After institutional review board approval, records for all patients treated surgically at our institution for calcaneus fractures from 2012 to 2017 were reviewed. Inclusion criteria were intra-articular calcaneus fractures, patients aged 18 years or older, and use of the sinus tarsi approach. Exclusion criteria were open fractures and fractures with less than 6 weeks of postoperative weightbearing, which were excluded for radiographic outcomes. A total of 51 fractures underwent ORIF using cannulated screws alone (group 1), and 23 fractures underwent ORIF using a sinus tarsi plate (group 2). Sixty-one fractures (41 vs 20, respectively) met criteria for radiographic comparison. The primary outcomes of interest included pre- and postoperative Bohler and Gissane angles, wound complications, unplanned return to the operating room (OR), and cost comparison. Results: There was no statistically significant difference between preoperative Bohler angles for group 1 (14.4 degrees) versus group 2 (12.2 degrees) ( P = .44), nor was there a significant difference between postoperative Bohler angles for group 1 (30.1 degrees) versus group 2 (27.1 degrees) ( P = .14). Similarly, preoperative Gissane angles for group 1 (130.5 degrees) and group 2 (133.4 degrees) ( P = .54) and postoperative Gissane angles for group 1 (118.2 degrees) and group 2 (119.8 degrees) ( P = .44) showed no statistically significant difference. There were a total of 3 wound complications in group 1 versus 2 wound complications in group 2 ( P = .66). There was no statistically significant difference in operative duration ( P = .97) or the number of unplanned returns to the OR between the 2 groups ( P = .68). Based on the implants used at this institution, and depending on the number of screws used, the estimated cost range of a plate construct was $1070 to $1235, while the estimated cost range of a cannulated screw construct was $717 to $1264. Conclusion: When comparing the cannulated screw and plate and screw fixation techniques, there was no difference in restoration of the Bohler and Gissane angles. Furthermore, the amount of angular correction achieved by initial reduction showed no statistically significant difference between groups, and the amount of reduction lost between initial and final postoperative radiographs showed no statistically significant difference between groups. With regard to the 2 techniques, there was no statistically significant difference in rates of postoperative complications and return to the OR. Our data suggest that fixation using cannulated screws alone versus sinus tarsi plate provides similar radiographic outcomes and risk of complications. The 2 techniques were also similar in terms of implant costs. Our results indicate that either technique effectively improved radiographic parameters. Level of Evidence: Level III, retrospective comparative study.

Comparison of Two Surgical Approaches for Displaced Intra-Articular Calcaneal Fractures: The Modified Sinus Tarsi Approach Versus The Extensile Lateral Approach

“…According to the previous reports, it is worth noting that although the use of minimally invasive techniques can effectively reduce the occurrence of soft tissue complications, the sinus tarsi approach still suffers from poor visualization, inadequate reduction, and unreliable xation when compared to the ELA 19 . More speci cally, the reduction of incision-related complications requires minimal incisions, while intra-articular fractures require good anatomic reduction 4,20 . The fragility of the calcaneus requires strong internal xation, especially in the treatment of older patients with comminuted calcaneal fractures, severely compressed articular surface calcaneal fractures, and osteoporotic fractures.…”

“…For displaced intra-articular calcaneal fractures (DIACF), open reduction and internal xation (ORIF) is generally recommended 3 . Conservative treatment may cause malunion, subtalar arthritis, sub bular impingement and other sequelae, resulting in dysfunction or disability 4 . The primary goal of ORIF for DIACF is to restore the congruence of the subtalar joint.…”

Intra-articular Transcalcaneal Fracture-Dislocation Associated With Ipsilateral Transtalar Fracture: A Report of a Rare Combination

“…However, it is unknown if plates represent the most accurate fixation to restore radiographic alignment. [14][15][16] The decision to use screws rather than a plate was based on the soft-tissue conditions and preference of the surgeon. Because it was an open fracture caused by a high-energy trauma, soft tissues were always a concern in the surgical planning.…”

Comparison of Two Surgical Approaches for Displaced Intra-Articular Calcaneal Fractures: The Modified Sinus Tarsi Approach Versus The Extensile Lateral Approach

“…According to the previous reports, it is worth noting that although the use of minimally invasive techniques can effectively reduce the occurrence of soft tissue complications, the sinus tarsi approach still suffers from poor visualization, inadequate reduction, and unreliable xation when compared to the ELA 18 . More speci cally, the reduction of incision-related complications requires minimal incisions, while intra-articular fractures require good anatomic reduction 4,19 . The fragility of the calcaneus requires strong internal xation, especially in the treatment of older patients with comminuted calcaneal fractures, severely compressed articular surface calcaneal fractures, and osteoporotic fractures.…”

“…For displaced intra-articular calcaneal fractures (DIACF), open reduction and internal xation (ORIF) is generally recommended 3 . Conservative treatment may cause malunion, subtalar arthritis, sub bular impingement and other sequelae, resulting in dysfunction or disability 4 . The primary goal of ORIF for DIACF is to restore the congruence of the subtalar joint.…”