Open reduction and internal fixation of depressed intra-articular calcaneal fractures through a miniopen approach

Abstract

Background Fractures of the calcaneus pose a great challenge both to surgeons and patients. They are considered life-changing injuries. Anatomical reduction of fragments is one of the important variables affecting outcome. Extensile lateral approach has been used widely to facilitate good visualization and reduction. Skin complications like wound infection and dehiscence are a major concern. Therefore minimally invasive approaches came to fame. However, the use of less rigid fixation in minimally invasive techniques has led to inferior results. Aim The aim was to combine the merits of rigid fixation and minimally invasive approaches. Patients and methods Twenty-three patients with calcaneal fractures were operated upon and followed for a mean of 6 months. All patients were operated upon in the prone or lateral position under tourniquet. A miniopen sinus tarsi approach was used for fracture reduction and fixation. The latter was achieved using a calcaneal miniplate and screws. Patients were assessed radiographically for restoration of Bohler and Gissane angles, clinically using American Orthopedic Foot and Ankle Society score (AOFAS) and the visual analog score for pain. Results All patients showed a significant improvement in the mean Bohler and Gissane angles. The majority of the patients scored very good on the AOFAS score, the mean being 83 ± 4. The mean visual analog scale was 3. Mean time to full weight bearing was 12.5 ± 2 weeks after full radiological union was achieved. Conclusion Miniplate fixation through miniopen approach combines the merits of open reduction and internal fixation and minimally invasive techniques. Longer follow-up is however required to establish its superiority over screw-only fixation constructs.