Publication:

Comparison of open reduction internal fixation by lateral extensile approach versus conservative management in sanders type 2 and 3 calcaneum fractures: a prospective, two-arm, parallel group study

Background Calcaneum bone is the most common tarsal bone to get fractured. It accounts for 50-60% of all fractured tarsal bones. Calcaneum fractures are always debilitating and are challenging and cumbersome to treat. There is a paucity of Indian studies to assess the comparative treatment outcomes of calcaneal fractures treated by non-operative conservative procedure and open reduction internal fixation by lateral extensile approach.

Methods Adult patients with closed intra-articular calcaneum fractures of Sanders type 2 and 3 were enrolled. Patients managed by cast application (non-operative) or open reduction internal fixation (operative) were separated into two groups. The VAS score for pain, range of motion, radiological angles (Bohler’s and Crucial angle of Gissane) and parameters, functional scores American orthopedic foot and ankle society and Maryland foot score were evaluated sixth month and 1-year post-intervention and compared between the study groups. Descriptive statistics were used for statistical analysis.

Results 29 patients managed with open reduction internal fixation (N=15) or cast application (N=14) were enrolled. The mean age of patients was 39.54±7.81 years, 22 being males and 7 females. Mean VAS score was significantly lower in the plating group at sixth month (4.31+0.69 vs. 5.01+0.66, p<0.05) but not significant at 1 year (1.25+1.09 vs. 1.86+0.77, p<0.05). Range of movements at the ankle and subtalar joints were higher in the operative group. Mean Bohler’s angle was significantly higher and Gissane’s angle lower in the operative group (p<0.05). Significantly higher AOFAS and Maryland scores were noted in the operative group (p<0.05). Subtalar arthritis with malunion was more common in the non-operative group.

Conclusions Operative open reduction and internal fixation methods were found to be significantly better than the conservative management of calcaneus fracture based on clinical, radiological and functional outcomes. Results are most favourable    if wound complications are minimized.