Comparative study of three surgical techniques for intra-articular calcaneus fractures: open reduction and internal fixation with a plate, external fixation, and minimally invasive surgery

Abstract

Objective: To evaluate, compare and identify surgical technique that provide the best results for the treatment of intra-articular calcaneal fractures on the basis of postoperatory, complications and scores on American Orthopaedic Foot & Ankle Society (AOFAS) scale. Methods: This retrospective study included 54 patients with fractures of the calcaneus who had undergone surgery between 2002 and 2012 by one of three methods: 1) open reduction with extended “L” shaped lateral incision and fixed with a 3.5mm double “h” plate, 2) open reduction with an economic lateral incision and percutaneous fixation with wires and screws, and 3) open reduction with an economic lateral incision and fixation with adjustable monoplanar external fixator. Results: The average AOFAS scores were 76 among patients treated with lateral access and plate fixation, 71 among those treated with economic lateral incision and fixation with wires and screws, and 75 among those treated with lateral economic incision and external fixator. The three surgical techniques showed efficacy for the treatment of intra-articular calcaneal fractures. No evidence of superiority of a specific technique was found comparing one to another. Conclusion: Intra-articular calcaneal fractures are complex and treatment should be individualized according to patient characteristics, type of fracture and the surgeon’s experience with the chosen surgical technique.