The surgical treatment of intra-articular calcaneal fractures (comparison of two different methods)

Objective: "Close reduction & percutanous fixation with K wire" (CR-PF) technique is new and not common in use. In our study clinic and radiologic results of patients treated with "Open reduction & internal fixation with plate and screw" (OR-IF) and CR-PF are compared. Material and method: Between June 2008 and December 2012, in Dicle University Faculty of Medicine Department of Orthopaedics and Traumatology, using OR-IF and CR-PF for displaced intraarticular calcaneus fracture, 64 feet of 50 patients are operated. Patients operated average in 4.3 days (1-13). In 27 fracture (%42,2) OR-IF technique (Group I) and in 37 fracture (%57,8) CR-PF technique (Group II) applied. Group 1 had 16 male, 4 female patients and the average age was 30. Group 2 had 17 male, 13 female patients and the average age was 26.6. According to Sanders fracture classification 23 fracture in Group 1 (%35.9) were Sanders type III, 4 fracture (%6.3) were Sanders type IV. Two of calcaneus fractures in Group II (%3.1) were Sanders type II, 21 (%32.8) were Sanders type III, 14 (%21.9) were Sanders type IV. Patients pre and post op Böhler angles' measured and clinical evaluation made according to AOFAS Hind Foot Score System. Findings: Patients average follow up time was 32,5 months (10-54). There was statistically significant relationship between fracture type and the clinic results (p=0.017). Group I's pre op average 7.59 (-22_28) degrees of Böhler angle was post op 21.03 (8-36), Group II's pre op average 0.70 (-36_20) degrees of Böhler angle was post op 16.94 (-18_36) determined. Group I has better restoration in Böhler angle but as the functional results there was not a significant difference between Group II (p>0,05). The improvement in Böhler angle has a positive corelation with satisfactional clinical results (Group I,p=0.004; Group II,p=0.013). Böhler angle was found to be only a limited effect on clinical results alone (p=0,001). Average AOFAS score was 89.8 points in Group I, 85.4 points in Group II and there was not a statistically significant difference between the groups (p>0,05). v Result: It can be said that in treatment of intraarticular displaced calcaneus fractures, OR-IF technique is a better way for satisfactional clinical results. However in this study the clinical results that we achieved with CR-PF technique to be comparable with OR-IF technique, also lower soft tissue damage, lower complication ratio and applicability in less time to minimize the increase of the trauma effect, we think that in properly chosen patient groups (patients with lower recovery potential because of accompanying diseases, patients with additional system injuries and multipl fractures) CRPF technique is an effective treatment technique. Keywords: Calcaneus; displaced; fracture; closed; percutan