BACKGROUND: The calcaneal fracture is the most common tarsal bone fracture. Approximately 75% calcaneal fractures presented as the displaced intraarticular fractures. How to treat intraarticular calcaneal fractures remains controversial.
OBJECTIVE: To observe the anatomy and clinical effect of minimally invasive percutaneous screw fixation in repair of Sander II calcaneal fractures under the arthroscope.
METHODS: From May 2009 to May 2012, 61 patients (61 feet) with Sander II calcaneal fractures were repaired by minimally invasive percutaneous screw fixation under the arthroscope. All patients received clinical and imaging evaluation at 3, 6, 21 weeks, and 1 year after treatment. From then on, the evaluation was performed every year. American Orthopaedic Foot and Ankle Society ankle hindfoot score was used to assess ankle joint function. Simultaneously, complications such as skin necrosis and wound infection were recorded. Radiographic outcomes were assessed by Bohler angle, Gissane angle, calcaneal height and width.
RESULTS AND CONCLUSION: A total of 61 patients were followed up for 24 to 60 months. No complications were seen such as wound healing or deep infection. The time of hospitalization was 6-25 days, averagely (12.7±6.9) days. At the final follow-up, American Orthopaedic Foot and Ankle Society ankle hindfoot score was 88-100, averagely (93.6±3.1), with an excellent and good rate of 100%. The time of return to work after treatment was 8-14 weeks, averagely (10.7±2.9) weeks. Range of motion of ankle or subtalar joint of all patients was limited less than 10°. Immediate postoperative X-ray showed that anatomic reduction of the articular surface was detected in 56 patients (92%), and non-anatomic reduction was found in 5 patients (8%). At last follow-up, the mean Bohler angle was (28.4±4.9)° (range, 23°-30°); the mean Gissane angle was (119.9±7.8)° (range, 112°-124°); the mean calcaneal height was (43.4±4.2) mm (range, 39-45 mm); the mean calcaneal width was (30.4±2.5) mm (range, 27-32 mm); the average fracture healing time was (16.7±4.2) weeks (range, 12-20 weeks). Bohler angle, Gissane angle, calcaneal height, and calcaneal width at last follow-up were significantly improved compared with pretreatment (P < 0.05). These findings suggest that under the arthroscope, minimally invasive percutaneous screw fixation for Sander II calcaneal fractures can restore calcaneal anatomy, achieve a satisfactory clinical function, without complications such as poor woundhealing or infection.
中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程