Open reduction and internal fixation with Calcaneal anatomical plate via Subtalar arthroscopic assisted minimal incision approach for displaced intra-articular calcaneal fractures

Abstract

Objective : The open reduction and internal fixation with Calcaneal anatomical plate via Subtalar arthroscopic assisted minimal incision approach for displaced intra-articular calcaneal fractures is to verify if the method can achieve the operation standard without any wound complication. Since the current standard operation method (ELA) for intra-articular calcaneal fractures can achieve a good result but not without noticeable wound complication. Furthermore, the minimal invasive operation (STA) still has some limitations of joint reduction.

Method : The radiologic data of Böhler’s angle, Calcaneal length, height, and width, and posterior facet residual stepping/gapping data were labeled to display the injury conditions. We collected and compared the data of the pre-operation, post-operation, and uninjured calcaneal bone. We collected the Thai FAAM clinical data three and six months after the operation. We collected the wound complication, time to operation, length of the operation, and length of the hospital stay period data. All the data are collected from the patients diagnosed with displaced intra-articular calcaneal fractures Sander classification IIA, IIB, III at Bhumibol Adulyadej hospital from April 1st, 2019 to December 31st, 2021

Result : From the post-operation data of twelve suitable candidates, the median (min, max) of Böhler’s angle, Calcaneal height, width, Stepping, and Gapping data in order are at 21.34 (16.64, 39.43), 39.78 (34.91, 50.3), 36.41 (29.09, 42.51), 0 (0, 2.36), 1.62 (1.39, 3.32). Which were significantly different from the pre-operation data with P = 0.002, 0.034, 0.003, 0.004, 0.002 in the same order. By comparing them with the data from the uninjured one,                the Böhler’s angle was still significantly different from the post-operation with P =0.01,                The Calcaneal length, height, and width were insignificantly different from the post-operation data. This method can achieve 66.67% anatomical reduction, 25% nearly anatomical reduction, and 8.33% approximately anatomical reduction. The Thai FAAM clinical data after three and six months did have a significant difference only in the point of daily activity. There was no reported serious wound complication. The average day to surgery was 18±6.34 days, the average length of the operation was 199.92±81.26 minutes and the average length of the hospital stay was 22.42±12.61 days.

Conclusion : From the research, we found that the operation performed well in terms of radiological and clinical outcomes without any severe wound complication. This can be applied on operations for patients diagnosed with Displaced intra-articular calcaneal fractures (DIACF) type Sander IIA, IIB, III. Still, the length of operation has to be reduced to be closer to the current method. With the constraints of small sample size, length of the follow-up period, and that we need to compare to more operational methods, more experimental studies are needed to get a more accurate and reliable conclusion for future applications.