Calcaneus traction compression with orthopaedic reduction forceps combined with percutaneous minimally invasive treatment of intra-articular calcaneal fractures: An analysis of efficacy

Background: The treatment of displaced calcaneal fractures is controversial.Open reduction and internal fixation are widely described as the gold standard in the literature,but these technique shave many complications,including skin necrosis,internal fixation leakage and deep infection and wound healing problems.Percutaneous reduction and unilateral external fixation have received increasing attention because they can provide a good, stable reduction and reduce the soft tissue complications caused by open surgery(such as deep infection and delayed wound healing).The purpose of this retrospective study was to evaluate the reduction imaging and clinical results of calcaneus traction compressionwith orthopaedic compression reduction forceps combined with percutaneous minimally invasive external fixation for infra-articular calcaneal fractures. Methods: This was a retrospective analysis. A total of 35 patients with unilateral calcaneal fractures were divided into two groups: 1) the open reduction, internal fixation group (19 feet)and 2) the percutaneous minimally invasive, closed reduction external fixation group (16 feet).Evaluation of the reduction include dimaging measurements of the calcaneus length,width,and height,and the Bohler angle and Gissane angle before and after surgery.Clinical outcomes included the time of surgery,length of hospital stay,operation time,wound-related complications,the American Orthopaedic Foot and Ankle Society hindfoot score,the visual analogue score for pain, and the SF-36 score. Results: The average follow-up time was 25.52 +/- 1.68 months.There was no significant difference in reduction between the open group and the closed group (P > 0.05).The operation time of the open group was significantly longer than that of the closed group(P = 0.0001).The length of hospitalization and waiting time for surgery in the open reduction group were significantly longer than those in the closed reduction group (P < 0.05),Incidence-related complications in the open group and closed group were 21.1 %(4/19) and 6.3 %(1/16),respectively (P = 0.0001).The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scores in the open and closed groups were 81.35 +/- 5.25 and 82.52 +/- 4.78, respectively (P = 0.0875). The visual analogues cale (VAS) scores of the open group and the closed group were 1.81 +/- 1.32 and 0.78 +/- 0.91, respectively (P = 0.0412).The SF-36 scores were 80 +/- 4.5 and 79 +/- 4.2, respectively. Conclusion: Our research shows that for various types of infra-articular calcaneal fractures compared with open reduction,internal plate fixation,calcaneus traction compression with orthopaedic reduction forceps combined with percutaneous minimally invasive external fixation is a simple and effective method for treating calcaneal fractures; not only can the calcaneus be corrected, but it can also provide notable imaging and clinical results.