Subtalar joint arthroscopic-assisted reduction and hollow screw fixation versus open reduction and internal fixation for treating displaced intra-articular calcaneal fractures

Abstract

Background The treatment of calcaneal fractures is not uniform. This study aimed to compare the functional and imaging results of subtalar arthroscopic reduction combined with hollow screw fixation (SJAHF) and the extended lateral approach (ELA) for the treatment of Sanders type II and III displaced intra-articular calcaneal fractures (DIACFs). Methods From January 2020 to January 2023, 60 patients with calcaneal fractures were treated with SJAHF or ELA for foot and ankle surgery at the Second Affiliated Hospital of Anhui Medical University. Changes in calcaneal Böhler’s angle, the Gissane angle, length, height, and width were recorded before, after, and at the 1-, 3-, 6-, 12-month, and last follow-up. The preoperative waiting time, operation time, hospital stay, and other data of each patient were analyzed. The visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores were used to evaluate clinical effects. Results All 60 patients were followed up for at least 12 months. There was no statistical difference in baseline data between groups (P > 0.05). The SJAHF group was superior to the ELA group regarding the preoperative waiting time, hospital stay, and intraoperative fluoroscopy times; however, the operative time of the SJAHF group was greater (P < 0.05). There were no significant differences in Böhler’s angle, the Gissane angle, length, height, or width between the two groups at any time point (P > 0.05). These imaging values were significantly improved after surgery and at the last follow-up (P < 0.05). The VAS scores of the patients in the SJAHF group at the last follow-up were significantly different from those in the ELA group (P < 0.05). The final AOFAS score and incidence of postoperative complications in the SJAHF group were better; however, the difference was not statistically significant (P > 0.05). Simultaneously, total weight-bearing and time to return to work in the SJAHF group were earlier (P < 0.05). Conclusion Both SJAHF and ELA improved the clinical outcomes of patients with DIACFs. SJAHF reduces surgical wounds and maintains effective reduction and strong internal fixation. It has the advantages of a reduced preoperative waiting time, shortened hospital stay, reduced intraoperative fluoroscopy time, alleviated postoperative pain, and accelerated patient recovery.