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
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Article info
Publication history
Published online: September 27, 2022
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
We obtained approval from our institution's review board (Vanderbilt University Medical Center, IRB# 202173), after a full review.
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