Percutaneous cannulated screw fixation vs open reduction and plate fixation for displaced intra-articular Sanders II and III calcaneal fracture: A two-center retrospective propensity-matched analysis.

Background: The optimal surgical strategy for treating displaced intra-articular calcaneal fractures remains controversial.

Purpose: The purpose of this retrospective cohort study was to compare the clinical and radiologic outcomes of percutaneous cannulated screw fixation versus open reduction and plate fixation via the sinus tarsi approach in patients with displaced intra-articular Sanders II or III calcaneal fractures.

Study design: A retrospective analysis was performed on the records of patients with displaced Sanders II or III calcaneal fractures.

Methods: We analyzed data from 124 patients using propensity score matching applied at a 1:1 ratio. The primary outcome was assessed using the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale for evaluating ankle function. Secondary outcomes included radiological outcomes, operative time, postoperative Visual Analogue Scale, wound complication rates, and hardware removal rates.

Results: There was no statistical difference in the American Orthopaedic Foot and Ankle Society ankle-hindfoot Scale (p=.104) and radiological outcomes (Böhler's angle, p=0.21; Gissane's angle, p=0.29) between the two groups. The percutaneous cannulated screw fixation group demonstrated better ankle-hindfoot complex motion, shorter operative time (65±35 mins vs 95±40 mins), lower postoperative Visual Analogue Scale (5±1 vs 8±1.5), fewer wound complications (3.2 % vs 9.6 %), and no hardware removal needed (0 % vs 14.5 %).

Conclusion: This study suggests that both techniques achieved comparable functional and radiographic outcomes for displaced intra-articular Sanders II or III calcaneal fractures; however, percutaneous cannulated screw fixation demonstrated favorable advantages in several aspects.