A comparison of two minimally invasive procedures for intra-articular displaced calcaneal fractures in older children

The purpose of this study was to compare the clinical outcomes of displaced intra-articular calcaneal fractures in older children treated with poking reduction and cannulated screws fixation or with plate fixation using a sinus tarsi approach. From June 2008 to May 2012, fifty patients were randomised to operative stabilisation either by poking reduction and cannulated screws fixation (Group A, 28) or by plates fixation using a sinus tarsi approach (Group B, 22). The two groups were comparable with respect to age, gender, BMI, the affected side, cause of injury, fracture type, time from injury to surgery and follow-up time. We collected data on operative time and radiation time, length of hospitalization, hospital costs, union time, full weight-bearing time, full physical activity time and complications and measured joint function using the American Orthopaedic Foot and Ankle surgery (AOFAS) score. The average follow-up time of Group A was 36.5 +/- 9.3 months and 40.2 +/- 10.6 months in Group B. No significant difference between these two groups was found in radiation time, average length of hospitalization, union time, full weight-bearing time, full physical activity time and the average AOFAS score. However, the patients of Group B had longer operation time (38.0 +/- 10.6 min vs. 66.5 +/- 9.4 min, P<0.05) and more hospital costs (6200 +/- 800 RMB vs. 15000 +/- 2000 RMB, P<0.05). The average Bohler's angle and Gissane's angle preoperative were 10.9 +/- 5.3 and 141.3 +/- 12.1 in Group A, and became 31.2 +/- 5.1 and 128.5 +/- 5.4 after operation. The average Bohler's angle and Gissane's angle preoperative in Group B were 11.7 +/- 4.0 and 138.8 +/- 16.2, respectively, and they became 30.9 +/- 5.2 and 124.6 +/- 6.8 after operation. Bohler's angle and Gissane's angle were significantly restored after surgery (P<0.05). Postoperative incision pain was more frequent in Group B than in Group A (P<0.05). Our results indicated that both cannulated screws and plates were efficient methods for intra-articular calcaneal fractures in older children. However, poking reduction and cannulated screws fixation had the advantages of a shorter operative time, fewer hospital costs and less incision pain.