Clinical, radiological and functional outcomes of patients with calcaneal fractures treated with open and close surgical techniques

Aim: Calcaneal fractures are more common in working males between the ages 30-40 that have an active lifestyle. In patients with untreated, nontreatable cases or cases with complications, there is severe loss of manpower alongside socioeconomic problems for the patient and his environment. The aim of our study is analyze the clinical, functional and radiologic outcomes of patients operated with different surgical techniques. Method: In our study, patients that were operated due to calcaneal fractures at Necmettin Erbakan University Meram Faculty of Medicine, Department of Orthopaedics and Traumatology in 2010 and later and that presented for follow- ups regularly for at least 6 months were selected and retrospectively studied. All patients were evaluated with standart Ap and lateral radiographs and Computer Tomography scans at admission to emergency department. Sanders classification was used for categorization. Time until surgical intervention and the duration of hospitilization was noted. The Böhler and Gissane angles were measured in preoperative, postoperative and follow-up X-rays. Functional outcomes evaluated with AOFAS Scoring System at the 3rd and 6th months of follow-up. Peroperative and postoperative complications during the follow-ups were also noted. The IBM SPSS Statistics Version 25.0 packet program was used in the stastical analysis of data. Results: In our study, a total of 92 calcaneal fractures of 83 patients was operated. There are 20 female and 63 male with the mean age of 36.55 years (range, 16 -76). The most common etiology of calcaneal fractures was high falls. The most common fractures were Sanders type 3AC (%22.8) and Sanders type 2A (%19.6). There were open calcaneal fractures in 9 patients. Close reduction and percutaneous fixation was done for 68 patients. Open reduction via sinus tarsi approach and internal fixation with vi plate for 8 patients and open reduction via extensile lateral approach and internal fixation with plate for 16 patients were preferred. Subtalar artritis was the most common complicatio. The second most common complication was surgical site problems (infection, flap necrosis) which was more common in patients treated with the extensile lateral exposure and fixation with plate. Corection amount of Böhler angle was correlated with functional score significantly (p=0.004). When we compared the clinical, functional and radiological outcomes of different surgical techniques, radiological outcomes between the groups were similar and there was no significant difference (p=0.10). The best significant functional outcome was obtained in patients operated with the sinus tarsi approach and internal fixation group (p=0.02). The need for secondary surgical intervention due to complicaitons were more frequent in patients operated with the extensile lateral exposure. Coclusion: Recent studies have indicated that there better clinical, functional and radiological outcomes in patients operated with minimally invasive and close surgical techniques, compared with invasive techniques, and our study supports this especially in fuctional scores. According to our results of this study we suggest external guide supported close reduction percutaneous fixation or open minimally invasive techniques in calcaneal fractures, including in Sanders type 3 and 4. Keywords: Calcaneal fractures, extensile lateral approach, minimally invasive, sinus tarsi approach, closed reduction percutaneous fixation, AOFAS score