Functional and radiographic outcomes following percutaneous fixation of intra-articular calcaneal fractures: a systematic review

The management of displaced intra-articular fractures of the calcaneus remains controversial due to the soft tissue complications associated with the traditional extensile lateral surgical approach. Minimally invasive percutaneous techniques have been developed with the aim of restoring calcaneal shape while reducing wound complications. This review evaluated functional and radiographic outcomes following percutaneous fixation of displaced intra-articular fractures of the calcaneus. A systematic search of MEDLINE and EMBASE databases identified studies that reported functional outcomes or radiographic measurements after percutaneous fixation. Data on patient demographics, fracture classification, operative technique, outcomes, complications, and study quality were extracted. Eight studies comprising 295 patients and 309 fractures met inclusion criteria. All studies included fractures of Sanders type three, seven included fractures of Sanders type two, and two reported fractures of Sanders type four. The average follow-up period across all studies was 29.2 months. Functional outcomes were favourable, with a pooled average score on the American Orthopaedic Foot and Ankle Society hindfoot scale of 85.6 across all studies and an average Maryland foot score of 88.9 across two studies. Radiographic correction was maintained at final follow-up, with improvements in both Böhler and Gissane angles reported in five studies. Five studies were assessed as high quality and three as low quality. Percutaneous fixation of displaced intra-articular fractures of the calcaneus provides reliable functional improvement, satisfactory restoration of radiographic parameters, and a lower rate of wound complications compared with open reduction and internal fixation. Larger, high-quality prospective studies are required to define the optimal minimally invasive method. Level of clinical evidence: 2