Short-term Evaluation of Percutaneous Screw Fixation Assisted with Intraoperative Simple Distraction Frame in the Treatment of Intraarticular Calcaneal Fractures

Background: Percutaneous screws for displaced intraarticular calcaneal fractures (IACFs) involves closed reduction under fluoroscopy. Benefits include decreased surgical dissection, preservation of fracture hematoma for biological healing, and relatively stable internal fixation. Patients and Methods: Retrospective study of skeletally mature with closed, displaced intraarticular calcaneal fractures. Exclusion criteria were open fractures, pathologic fractures, and polytrauma patients with associated ankle or foot injury. Percutaneous reduction and elevation of depressed posterior articular surface with small 5 mm incision on lateral side opposite sinus tarsi. Multiple K-wires were inserted to hold reduction temporarily. Definitive fixation was done by percutaneous two cannulated 6.5 mm fully threaded screws from posterior tuberosity. Transverse stabilization was maintained by insertion of one or two cannulated 4 mm screws from lateral to sustentaculum Tali beneath the articular surface. Postoperative visits were scheduled for 6 weeks, 3 months, 6 months and 12 months. Results: 21 feet in 14 patients with mean age of 36.4. Mean Böhler's angle improved from 8.5⁰ preoperatively to 27.1⁰ postoperatively (P=0.002). Mean Gissane’s angle decreased from 167.7⁰ to 132.8⁰ (P=0.007). anatomic reduction was achieved in 13 feet, imperfect reduction in 4 feet, and poor reduction in 1 foot. Mean time to radiographic healing was 12 weeks. At the most recent follow-up, mean AOFAS score was 84.3, mean Maryland foot score (MFS) was 83.6, and the mean VAS pain score was 2.4. Conclusion: Intraoperative subtalar distraction by simple frame has effectively facilitated percutaneous reduction and fixation of IACFs, proper restoration of calcaneal parameters, and satisfactory clinical outcomes over short-term follow up.