Radiological outcomes following open versus percutaneous fixation versus arthroscopically assisted percutaneous fixation of calcaneal fractures: a retrospective observational study

D. Yeomans, T. Lewis, T. Pearks, B. Stone, S. Hepple, A. Riddick, W. Harries, M. Kelly, I. Winson, P. Robinson

Background: Calcaneal fractures are often major injuries associated with considerable morbidity. The optimal surgical management of displaced calcaneal fractures remains contentious with open, percutaneous and arthroscopically-assisted percutaneous approaches all offering potential benefits for patients. The aim of this study was to assess which of these three separate surgical approaches to the management of displaced calcaneal fractures provides the best radiographic deformity correction.

Methods: A retrospective observational study of all calcaneal fractures undergoing operative fixation at a single major trauma centre in the United Kingdom. The primary outcome was pre and post-operative assessment of the deformity correction using radiographic parameters (angle of Gissane and Bohler’s angle). Secondary outcomes included fracture configuration, complications, and re-operation rate.

Results: Between 01/01/2009 and 31/21/2019, 152 calcaneal fractures in 134 patients underwent operative management via either an open, percutaneous or arthroscopically assisted percutaneous approach. Three-way ANOVA testing of the pre- and post-operative radiographic parameters demonstrated that an open approach offered superior post-operative correction of Bohler’s angle when compared to percutaneous alone (p<0.05) however there was no difference in post-operative Angle of Gissane. The mean follow-up for complication and re-operation data was 3.5 years (range 0.1-12.4). Overall complication rate following surgical fixation was 7.2% with a further 32.2% requiring further long term surgical intervention for subtalar arthritis or removal of metalwork.

Conclusion: The optimal surgical approach for the management of displaced calcaneal fractures remains contentious. Arthroscopically assisted percutaneous fixation does not offer superior radiographic deformity correction compared to percutaneous technique alone. Complication and reoperation rates following surgical fixation of calcaneal fractures is high and patients should be counselled accordingly.