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Radiographic Outcomes of Plate vs Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi Approach

CATEGORY: Hindfoot, Trauma INTRODUCTION/PURPOSE: Intra-articular fractures of the calcaneus are a common injury to the hindfoot following high energy trauma to the lower extremity. Treatment of these fractures has evolved. Due to the concern of wound complications associated with extensile open trea...

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Autores principales: Pitts, Charles, Almaguer, Adam, Wilson, Jack, Johnson, Michael
Formato: Online Artículo Texto
Lenguaje:English
Publicado: SAGE Publications 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8696415/
http://dx.doi.org/10.1177/2473011419S00343
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author Pitts, Charles
Almaguer, Adam
Wilson, Jack
Johnson, Michael
author_facet Pitts, Charles
Almaguer, Adam
Wilson, Jack
Johnson, Michael
author_sort Pitts, Charles
collection PubMed
description CATEGORY: Hindfoot, Trauma INTRODUCTION/PURPOSE: Intra-articular fractures of the calcaneus are a common injury to the hindfoot following high energy trauma to the lower extremity. Treatment of these fractures has evolved. Due to the concern of wound complications associated with extensile open treatments, smaller incision techniques, such as the sinus tarsi approach, are increasing in popularity. A number of fixation strategies are utilized with this approach, and it is unknown which most accurately restores radiographic alignment. The purpose of this study is to compare the postoperative radiographic outcomes of a plate and screw construct versus a cannulated screw construct when using the sinus tarsi approach for open reduction and internal fixation (ORIF) of calcaneus fractures. METHODS: After IRB approval, records for all patients treated surgically at our institution for calcaneus fractures from 2012 to 2017 were reviewed. Inclusion criteria were intra-articular calcaneus fractures, patients aged 18 years or older, and use of the sinus tarsi approach. Exclusion criteria were open fractures and clinical follow up less than 6 weeks. A total of 51 fractures underwent ORIF using cannulated screws alone (Group 1), and 23 fractures underwent ORIF using a sinus tarsi plate (Group 2). The primary outcomes of interest included pre- and postoperative Bohler and Gissane angles, wound complications, and unplanned return to OR. RESULTS: There was no statistically significant difference between preoperative Bohler angles for Group 1 (14.5 degrees) versus Group 2 (12.3 degrees) (p=0.35), nor was there a significant difference between postoperative Bohler angles between Group 1 (30.1 degrees) and Group 2 (27.0 degrees) (p=0.09). Similarly, preoperative Gissane angles for Group 1 (128.4 degrees) and Group 2 (134.5 degrees) (p=0.17) and postoperative Gissane angles for Group 1 (116.7 degrees) and Group 2 (118.8 degrees) (p=0.44) showed no statistically significant difference. There were a total of 3 wound complications in Group 1 versus 2 wound complications in Group 2 (p=0.76). There was no statistically significant difference in operative duration (p=0.97) or the number of unplanned returns to the OR between the two groups (p=0.77). CONCLUSION: When comparing the cannulated screw and plate and screw fixation techniques, there was no difference in restoration of the Bohler and Gissane angles. Both techniques had similar rates of postoperative complications and return to the OR. Our data suggests that fixation using cannulated screws alone versus sinus tarsi plate provide similar radiographic outcomes and risk of complications. The two techniques are also similar in terms of implant costs. Our results indicate that either technique effectively improves radiographic parameters.
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spelling pubmed-86964152022-01-28 Radiographic Outcomes of Plate vs Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi Approach Pitts, Charles Almaguer, Adam Wilson, Jack Johnson, Michael Foot Ankle Orthop Article CATEGORY: Hindfoot, Trauma INTRODUCTION/PURPOSE: Intra-articular fractures of the calcaneus are a common injury to the hindfoot following high energy trauma to the lower extremity. Treatment of these fractures has evolved. Due to the concern of wound complications associated with extensile open treatments, smaller incision techniques, such as the sinus tarsi approach, are increasing in popularity. A number of fixation strategies are utilized with this approach, and it is unknown which most accurately restores radiographic alignment. The purpose of this study is to compare the postoperative radiographic outcomes of a plate and screw construct versus a cannulated screw construct when using the sinus tarsi approach for open reduction and internal fixation (ORIF) of calcaneus fractures. METHODS: After IRB approval, records for all patients treated surgically at our institution for calcaneus fractures from 2012 to 2017 were reviewed. Inclusion criteria were intra-articular calcaneus fractures, patients aged 18 years or older, and use of the sinus tarsi approach. Exclusion criteria were open fractures and clinical follow up less than 6 weeks. A total of 51 fractures underwent ORIF using cannulated screws alone (Group 1), and 23 fractures underwent ORIF using a sinus tarsi plate (Group 2). The primary outcomes of interest included pre- and postoperative Bohler and Gissane angles, wound complications, and unplanned return to OR. RESULTS: There was no statistically significant difference between preoperative Bohler angles for Group 1 (14.5 degrees) versus Group 2 (12.3 degrees) (p=0.35), nor was there a significant difference between postoperative Bohler angles between Group 1 (30.1 degrees) and Group 2 (27.0 degrees) (p=0.09). Similarly, preoperative Gissane angles for Group 1 (128.4 degrees) and Group 2 (134.5 degrees) (p=0.17) and postoperative Gissane angles for Group 1 (116.7 degrees) and Group 2 (118.8 degrees) (p=0.44) showed no statistically significant difference. There were a total of 3 wound complications in Group 1 versus 2 wound complications in Group 2 (p=0.76). There was no statistically significant difference in operative duration (p=0.97) or the number of unplanned returns to the OR between the two groups (p=0.77). CONCLUSION: When comparing the cannulated screw and plate and screw fixation techniques, there was no difference in restoration of the Bohler and Gissane angles. Both techniques had similar rates of postoperative complications and return to the OR. Our data suggests that fixation using cannulated screws alone versus sinus tarsi plate provide similar radiographic outcomes and risk of complications. The two techniques are also similar in terms of implant costs. Our results indicate that either technique effectively improves radiographic parameters. SAGE Publications 2019-10-28 /pmc/articles/PMC8696415/ http://dx.doi.org/10.1177/2473011419S00343 Text en © The Author(s) 2019 https://creativecommons.org/licenses/by-nc/4.0/This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).
spellingShingle Article
Pitts, Charles
Almaguer, Adam
Wilson, Jack
Johnson, Michael
Radiographic Outcomes of Plate vs Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi Approach
title Radiographic Outcomes of Plate vs Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi Approach
title_full Radiographic Outcomes of Plate vs Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi Approach
title_fullStr Radiographic Outcomes of Plate vs Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi Approach
title_full_unstemmed Radiographic Outcomes of Plate vs Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi Approach
title_short Radiographic Outcomes of Plate vs Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi Approach
title_sort radiographic outcomes of plate vs screw constructs in open reduction and internal fixation of calcaneus fractures via the sinus tarsi approach
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8696415/
http://dx.doi.org/10.1177/2473011419S00343
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