Subtalar joint arthroscopic-assisted reduction and cannulated screw fixation versus open reduction and internal fixation for treating displaced intra-articular calcaneal fractures.

backgroundThe treatment of calcaneal fractures is not uniform. This study aimed to compare the functional and imaging results of subtalar joint arthroscopic reduction combined with cannulated screw fixation (SJACF) and the extended lateral approach (ELA) for the treatment of Sanders type II and III displaced intra-articular calcaneal fractures (DIACFs).

methodsFrom January 2020 to January 2023, 60 patients with calcaneal fractures were treated with SJACF or ELA for foot and ankle surgery at the Second Affiliated Hospital of Anhui Medical University. Changes in calcaneal Böhler's angle, the Gissane angle, and calcaneal length, height, and width were recorded before, after, and at the 1-, 3-, 6-, 12-month, and last follow-up. The preoperative waiting time, operation time, length of hospital stay, and other data of each patient were analyzed. The visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores were used to evaluate clinical effects.

resultsAll 60 patients were followed up for at least 12 months. There was no statistical difference in baseline data (age, sex, fracture side, mechanism of injury, and classification) between groups (P > 0.05). The preoperative waiting time, length of hospital stay, and intraoperative fluoroscopy times were shorter in the SJACF group than in the ELA group; however, the operative time was greater in the SJACF group (P < 0.05). There were no significant differences in Böhler's angle, the Gissane angle, or calcaneal length, height, or width between the two groups at any time point (P > 0.05). These imaging values were significantly improved after surgery and at the last follow-up (P < 0.05). The VAS scores of the patients in the SJACF group were significantly different from those in the ELA group at the last follow-up (P < 0.05). The final AOFAS score and incidence of postoperative complications were better in the SJACF group; however, the difference was not significant (P > 0.05). Simultaneously, patients were able to return to work and achieve full weight-bearing earlier in the SJACF group (P < 0.05).

conclusionBoth SJACF and ELA improved the clinical outcomes of patients with DIACFs. SJACF reduces surgical wounds and maintains effective reduction and strong internal fixation. It has the advantages of a reduced preoperative waiting time, shortened hospital stay, reduced intraoperative fluoroscopy time, alleviated postoperative pain, and accelerated patient recovery.