Three-step closed reduction and percutaneous screw fixation: A reliable and reproducible protocol in managing displaced intra-articular calcaneal fractures

Background: For displaced intra-articular calcaneal fractures (DIACFs), the less invasive surgical techniques vary widely. Herein, the study is to introduce a novel, reliable and reproducible protocol of three-step closed reduction (distracting, elevating, and clamping) and percutaneous screw fixation for DIACFs. Methods: This retrospective study included 32 patients with 33 DIACFs treated by the abovementioned surgical procedures with an average follow-up of 17.7 months. Postoperative outcomes were evaluated by complications, radiographs, and functional scores. Results: There were no incision complications. Postoperative Bohler's angle, height, and width were significantly recovered with p < 0.001. Especially, mean postoperative subtalar incongruity was 0.5 +/- 0.5 mm. The average values of Maryland Foot Score (MFS) and American Orthopaedic Foot and Ankle Society (AOFAS) ankle hindfoot score were 93.6 +/- 5.9, 91.7 +/- 6.7, respectively. The average scores of short form-36 (SF-36) and visual analog scale (VAS) were 89.9 +/- 10.4 and 3.1 +/- 1.6, respectively. Further subgroup analysis showed that the functional scores were comparable among different fracture types according to either Sanders or Essex-Lopresti classification. Conclusion: We consider the three-step reduction (distracting, elevating and clamping) and percutaneous screw fixation to be a reliable and reproducible protocol for the treatment of DIACFs. (c) 2022 Elsevier Ltd. All rights reserved.