Comparison of Percutaneous Screw Fixation and Calcium Sulfate Cement Grafting Versus Open Treatment of Displaced Intra-Articular Calcaneal Fractures

Abstract

Background: The conventional treatment for displaced intra-articular fractures of the calcaneus (DIACF), with open reduction and internal plate fixation (ORIF), carries the risk of wound infection and delayed recovery. Alternatively percutaneous fixation techniques offer the possibility of equivalent outcomes with a reduction in soft tissue complications. The goal of the present study was to evaluate the outcome of percutaneous reduction (PR), screw fixation, and calcium sulphate cement (CSC) grafting in the treatment of DIACF. Methods: Ninety patients were randomly assigned to PR and CSC grafting or ORIF between January 2006 and August 2008. The blood loss, Böhler's angle, calcaneal width, length, height and articular congruity of the posterior facet, wound complication, range of joint motion were compared, function scores such as American Orthopaedic Foot and Ankle Society score (AOFAS) and Maryland foot score (MFS) were measured. Results: The quality of reduction was not significantly different between the two groups. There were significant differences favoring PR in blood loss ( p < 0.01), range of joint motion ( p < 0.01), AOFAS ( p < 0.01) and MFS ( p < 0.01) between the two groups. Postop infection was 12% ORIF and 3% PC ( p = 0.23). Earlier weightbearing in the PR group did not result in a greater frequency of redisplacement than in the OR group. Conclusion: Our results indicate that compared with ORIF, the percutaneous reduction, fixation and CSC grafting for treatment of DIACF might allow accelerated weightbearing activity, reduce joint stiffness and improve the patients' satisfaction. Level of Evidence: I, Prospective Radomized Trial