Percutaneous cannulated cancellous screw fixation v/s open reduction and internal fixation with plating for intra-articular calcaneal fractures

Abstract

Introduction: The calcaneus is the largest tarsal bone and the most commonly fractured. Calcaneal fractures account for about 2% of all fractures, with 75 percent of these being intra-articular. Anatomic restoration in intra-articular calcaneal fractures was not always associated with a positive outcome in terms of quality of life, hence the best treatment option is still up for debate. Open reduction and internal fixation (ORIF) is considered an exemplary modality for treating calcaneal fractures. Soft tissue complications after ORIF procedures, on the other hand, have been reported to be as high as 30%. Scholars have advocated external fixation, percutaneous cannulated cancellous screw fixation, and Schanz pin assisted reduction and fixation as minimally invasive methods to reduce postoperative problems. In the present study, we aim to study the outcome of intra-articular calcaneum fractures treated with percutaneous cannulated cancellous screws V/S open reduction internal fixation with calcaneum plates. Materials and Methods: 22 patients with intra-articular calcaneum fracture (with displacement > 2mm) were recruited for the study after taking informed written consent. Patients were divided randomly into 2 groups; Group A were treated with minimally invasive percutaneous cannulated cancellous (CC) screw fixation. While patients in Group B were treated with open reduction internal fixation (ORIF) with plating. The study was a randomized controlled trial conducted at Krishna Institute of Medical Sciences, Karad during the period of May-2020 to May-2021. Pre-operative and post-operative Bohler’s angles were calculated using PACS, functional outcome was assessed at 6 months post-operatively using AOFAS score and post operative pain was assessed using VAS score. Results: The present study indicated no significant difference in the post-operative maintenance of Bohler’s angle when operated by either of the techniques. But, functional outcome in terms of AOFAS score when assessed at the end of 6 months indicated an excellent and good outcome in patients operated with cannulated cancellous screws as compared to patients operated with ORIF with calcaneum plating. Post operative complications were reported significantly high in group of patients operated with ORIF with plating as compared to percutaneous CC screw group patients. Conclusion: Percutaneous minimally invasive fixation using cannulated cancellous screws are better choice than ORIF with calcaneum plating due to lesser post operative pain and soft tissue complications, better functional outcome in terms of AOFAS score and lesser implant related soft tissue complications.