Advertisement

Comparing Calcaneus Fracture Radiographic Outcomes and Complications after Percutaneous Pin versus Screw Fixation

Published:September 27, 2022DOI:https://doi.org/10.1053/j.jfas.2022.09.005

      Abstract

      Calcaneus fracture fixation is associated with high rates of morbidity and disability from wound complications, infection, subtalar arthritis, and malunion. Percutaneous fixation with Kirshner wires (K-wires) or screws may be implemented when soft tissue injury precludes an open approach. Although screws are thought to provide greater stability, limited data exists directly comparing fixation success of these implants. Medical record data from 53 patients (62 total fractures) surgically treated with percutaneous screws (28 fractures) or K-wires (34 fractures) for joint-depression calcaneus fractures at a large tertiary hospital were retrospectively reviewed. Bohler's angle and calcaneal varus were assessed from available radiographs at time of injury, postoperatively, and at final follow-up, and joint congruity was assessed postoperatively and at final follow-up. Complications were also extracted. There were no statistical differences in patient characteristics between surgical groups although a higher proportion of patients treated with K-wires compared to screws had other associated injuries (79% vs 42%, p = .01). A higher proportion of fractures treated with screws compared to K-wires maintained joint congruity at the final follow-up (69% vs 32%, p = .005). However, there were no statistically detectable differences in other postoperative radiographic metrics (p > .05). In conclusion, joint congruity was more often maintained with screw fixation although there was no statistical difference in restoration and maintenance of Bohler's angle or varus alignment. The difference in radiographic metrics was not correlated with secondary procedures, namely subtalar arthrodesis, and may not be clinically significant. Neither group was completely effective in attaining and maintaining reduction, and additional fixation strategies should be considered if feasible based on patient, injury, and soft tissue characteristics.

      Level of Clinical Evidence

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Cave EF.
        Fracture of the os calcis–the problem in general.
        Clin Orthop Relat Res. 1963; 30: 64-66
        • Eastwood D
        • Langkamer V
        • Atkins R.
        Intra-articular fractures of the calcaneum. Part II: open reduction and internal fixation by the extended lateral transcalcaneal approach.
        J Bone Joint Surg Br. 1993; 75-B: 189-195
        • Juliano P
        • Nguyen HV
        Fractures of the calcaneus.
        Orthop Clin North Am. 2001; 32: 35-51
        • Folk JW
        • Starr AJ
        • Early JS.
        Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures.
        J Orthop Trauma. 1999; 13: 369-372
        • Hsu AR
        • Anderson RB
        • Cohen BE.
        Advances in surgical management of intra-articular calcaneus fractures.
        J Am Acad Orthop Surg. 2015; 23: 399-407
        • Yu X
        • Pang QJ
        • Chen L
        • Yang CC
        • Chen XJ.
        Postoperative complications after closed calcaneus fracture treated by open reduction and internal fixation: a review.
        J Int Med Res. 2014; 42: 17-25
        • Cotton FJ
        • Henderson FF.
        Results of fractures of the os calcis.
        Am J Orthop Surg. 1916; 14: 290
        • Essex-Lopresti P.
        The mechanism, reduction technique, and results in fractures of the os calcis.
        Br J Surg. 1952; 39: 395-419
        • Harnroongroj T
        • Tangmanasakul A
        • Sudjai N
        • Harnroongroj T
        • Choursamran N.
        Measurement technique of calcaneal varus from axial view radiograph.
        Indian J Orthop. 2015; 49: 223
        • Hammond AW
        • Crist BD.
        Percutaneous treatment of high-risk patients with intra-articular calcaneus fractures: a case series.
        Injury. 2013; 44: 1483-1485
        • Tornetta P.
        Percutaneous treatment of calcaneal fractures.
        Clin Orthop Relat Res. 2000; 375: 91-96
        • Abdelgaid SM.
        Closed reduction and percutaneous cannulated screws fixation of displaced intra-articular calcaneus fractures.
        Foot Ankle Surg. 2012; 18: 164-179
        • DeWall M
        • Henderson CE
        • McKinley TO
        • Phelps T
        • Dolan L
        • Marsh JL.
        Percutaneous reduction and fixation of displaced intra-articular calcaneus fractures.
        J Orthop Trauma. 2010; 24: 466-472
        • Schuberth JM
        • Cobb MD
        • Talarico RH.
        Minimally invasive arthroscopic-assisted reduction with percutaneous fixation in the management of intra-articular calcaneal fractures: a review of 24 cases.
        J Foot Ankle Surg. 2009; 48: 315-322
        • Stulik J
        • Stehlik J
        • Rysavy M
        • Wozniak A.
        Minimally-invasive treatment of intra-articular fractures of the calcaneum.
        J Bone Joint Surg Br. 2006; 88-B: 1634-1641
        • Walde TA
        • Sauer B
        • Degreif J
        • Walde HJ.
        Closed reduction and percutaneus Kirschner wire fixation for the treatment of dislocated calcaneal fractures: surgical technique, complications, clinical and radiological results after 2–10 years.
        Arch Orthop Trauma Surg. 2008; 128: 585-591
        • Sanders R
        • Fortin P
        • DiPasquale T
        • Walling A.
        Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification.
        Clin Orthop Relat Res. 1993; 290: 87-95
        • Su Y
        • Chen W
        • Zhang T
        • Wu X
        • Wu Z
        • Zhang Y.
        Bohler's angle's role in assessing the injury severity and functional outcome of internal fixation for displaced intra-articular calcaneal fractures: a retrospective study.
        BMC Surg. 2013; 13: 40
        • Sanders R.
        Intra-articular fractures of the calcaneus: present state of the art.
        J Orthop Trauma. 1992; 6: 252-265
        • Buckley R
        • Leighton R
        • Sanders D
        • Poon J
        • Coles CP
        • Stephen D
        • Paolucci EO.
        Open reduction and internal fixation compared with ORIF and primary subtalar arthrodesis for treatment of sanders type iv calcaneal fractures: a randomized multicenter trial.
        J Orthop Trauma. 2014; 28: 577-583
        • Dhillon MS
        • Bali K
        • Prabhakar S.
        Controversies in calcaneus fracture management: a systematic review of the literature.
        Musculoskelet Surg. 2011; 95: 171-181
        • Biz C
        • Barison E
        • Ruggieri P
        • Iacobellis C.
        Radiographic and functional outcomes after displaced intra-articular calcaneal fractures: a comparative cohort study among the traditional open technique (ORIF) and percutaneous surgical procedures (PS).
        J Orthop Surg Res. 2016; 11: 92
        • Tantavisut S
        • Phisitkul P
        • Westerlind BO
        • Gao Y
        • Karam MD
        • Marsh JL.
        Percutaneous reduction and screw fixation of displaced intra-articular fractures of the calcaneus.
        Foot Ankle Int. 2017; 38: 367-374
        • Ni M
        • Mei J
        • Li K
        • Niu W
        • Zhang M.
        The primary stability of different implants for intra-articular calcaneal fractures: an in vitro study.
        BioMed Eng OnLine. 2018; 17: 50
        • Zhao W
        • Zhang Y.
        Comparison and predictive factors analysis for efficacy and safety of Kirschner wire, anatomical plate fixation and cannulated screw in treating patients with open calcaneal fractures.
        Medicine (Baltimore). 2019; 98: e17498
        • Schepers T
        • Ginai AZ
        • Mulder PGH
        • Patka P.
        Radiographic evaluation of calcaneal fractures: to measure or not to measure.
        Skeletal Radiol. 2007; 36: 847-852
        • Poigenfürst J
        • Buch J.
        [Treatment of severe fractures of the calcaneus by reposition and percutaneous bore wire fixation].
        Unfallchirurg. 1988; 91: 493-501
        • Sanders R.
        Displaced intra-articular fractures of the calcaneus*.
        J Bone Joint Surg Am. 2000; 82: 225-250
        • Russe OJ
        • Russe FG
        • Buch J
        • Ziernhöld G
        • Nones R
        [Clinical and radiologic late results following internal wire osteosyntheses of the calcaneus. Follow-up studies from four Austrian hospitals for accidents].
        Hefte Unfallheilkd. 1979; 134: 195-199
        • Sanders R
        • Vaupel ZM
        • Erdogan M
        • Downes K.
        Operative treatment of displaced intraarticular calcaneal fractures: long-term (10–20 years) results in 108 fractures using a prognostic CT classification.
        J Orthop Trauma. 2014; 28: 551-563