The Reproducibility of Conventional Minimally Invasive Osteosynthesis for the treatment of Intra articular Calcaneal fractures: The Traditional Technique is Regaining Popularity (prospective interventional study).

Abstract

Background: Despite the relative prevalence of intra-articular calcaneal fractures, definitive treatment is controversial. Historically the closed treatment of these injuries had been unsatisfactory. Avoid the soft tissue complications,several minimally-invasive approaches have been proposed throughout the history of calcaneal fracture treatment and recently gained popularity.

Objective: The aim of the study was to verify the effectiveness of minimally invasive osteosynthesis for the treatment of intra articular calcaneal fractures in 20 cases.

Patients and methods: Twenty one percutaneous and minimally invasive ostyosynsesis of calcaneal fractures in 20 patients were included in prospective interventional study. This study was done at Alzaitoun Specialized Hospital and Al-Azhar University hospitals between October 2022 and January 2024. These patients were followed up for at least 6 months post-operatively. This study included closed intra-articular calcaneal fractures type II and III in adult patients and excluded open, extra-articular, type I and IV fractures.

Results: The mean pre-operative Böhler's angle was 17.81 ± 4.48 (range 13 - 25 0) and the mean post-operative Böhler's angle was 29.24 ± 5.15 (range 25 - 40 0) The result was found to be highly significant (p-value <0.001) using paired-samples T test. Restoration of normal range Bohler angle was achieved. The mean pre-operative Gissane angle was 136.95 ± 13.84 (range 110 - 165 0) and the mean post-operative Gissane angle was 117.81 ± 15.66 (range 100 - 145 0). The result was found to be highly significant (p-value <0.001) using paired-samples T test. Restoration of normal range Gissane angle was achieved. These results were found to be highly significant. That meant improvement of Böhler' and Gissane angles after fixation. Sixteen patients (80%) started weight bearing at 12 weeks while two patients (10%) started weight bearing at 16 weeks and two patients (10%) started weight bearing at 10 weeks. Three patients developed superficial wound infection treated by aily dressing and antibiotics for one week. Two patients developed malnion, one patient developed Positional wrist drop, seven patients developed subtalar joint pain, three patients developed Implant com-plications and two patients developed Fixed flat foot.

Conclusion: We presented a minimally invasive technique for the treatment of intra-articular calcaneus fractures and could obtain results comparable with other minimally invasive techniques, avoiding the dangerous soft-tissue complications encountered with ORIF. most of cases, Böhler's angle, gissane angle and geometry of the calcaneus were restored to normal values. We believe that our minimally invasive technique is a valuable alternative for management of intra-articular calcaneal fractures.