Arthroscopy-assisted absorbable screw combined with Kirschner wire internal fixation for Sanders type III displaced intra-articular calcaneal fractures: a retrospective study.

Abstract

Objective: This study aimed to investigate the clinical efficacy of arthroscopy-assisted absorbable screw combined with Kirschner wire internal fixation in the treatment of Sanders type III displaced intra-articular calcaneal fractures.

Methods: Eighty patients diagnosed with Sanders type III displaced intra-articular calcaneal fractures and treated at Dongguan Hospital of Guangzhou University of Chinese Medicine in China from December 2020 to June 2023 were enrolled in this study. According to treatment protocol, these patients were divided into the A group (n = 40), which underwent subtalar arthroscopic reduction combined with absorbable screw and Kirschner wire internal fixation, and the H group (n = 40), which received hollow screw internal fixation via a modified tarsal sinus incision. Intraoperative metrics, including intraoperative blood loss and operation time, were comparatively analysed. Postoperative functional improvement, including parameters such as fracture healing time, pre- and postoperative Visual Analog Scale (VAS), American Orthopedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS), Maryland Foot Score (MFS), Tegner scores and radiological parameters such as Böhler's angle, Gissane's angle and calcaneus height and width, was also evaluated. The incidence and nature of postoperative complications were analysed.

Results: (1) No significant differences in intraoperative blood loss, operation time and postoperative fracture healing time were observed between the two groups (P > 0.05). (2) Postoperative follow-ups revealed significant improvements in VAS scores, AOFAS ankle-hindfoot scores, MFS scores and Tegner scores in both groups (P < 0.05). Compared with the H group, the A group demonstrated significantly superior AOFAS ankle-hindfoot and MFS scores at 3 and 12 months post operation and Tegner scores at 12 months post operation and at the last follow-up (P < 0.05). No significant differences in postoperative VAS scores were found between the two groups (P > 0.05). (3) Significant postoperative improvements were noted in Böhler's angle, Gissane's angle and calcaneal dimensions (P < 0.05), with no significant intergroup differences during follow-up (P > 0.05). (4) The patients in the A group returned to sports activities earlier (7.23 ± 3.4 months) than those in the H group (9.28 ± 3.99 months). (5) The A group exhibited a lower incidence of postoperative complications, with one case of traumatic arthritis (2.5%, 1/40) compared with four cases of peroneal tendonitis (10%, 4/40) in the H group (P < 0.05).

Conclusion: Arthroscopy-assisted absorbable screw combined with Kirschner wire internal fixation provides effective and satisfactory outcomes in terms of internal fixation, foot function and radiological improvements for Sanders type III displaced intra-articular calcaneal fractures. This approach is associated with a low incidence of postoperative complications and a quick return to sports activities. It may potentially obviate the need for secondary surgery for implant removal.

Clinical trial number: Not applicable.