Outcomes of Percutaneous Fixation in Intra-articular Calcaneal Fractures

Displaced intra-articular calcaneal fractures have been proven to be challenging for orthopaedic surgeons worldwide due to the poor clinical outcomes. Historically, the decision whether for fixation or conservative management depended mostly on the literature of the time, initially favouring conservative management but attitudes slowly shifted to operative intervention. Percutaneous fixation options have been increasingly popular for their ability for fracture reduction without skin and wound complications of the open method. A retrospective study of 17 patients with a total of 18 calcaneal fractures treated in our hospital by a single surgeon from January 2017 to December 2019 was conducted. Fixation was done percutaneously using cannulated screws, with the patients in a lateral position. Intraoperative imaging was done using a mini-image intensifier to visualise fracture reduction, and the O-arm was used in most cases. Using the Sanders classification, there were a total of 4 IIA, 3 IIB, 2 IIC, 2 IIIAB, and 7 IIIAC. Results showed that 16 calcaneal fractures (94%) had good to excellent outcomes with the American Orthopedic Foot and Ankle Society (AOFAS) score and Maryland Foot Score (MFS), while 14 calcaneal fractures (78%) showed good to excellent outcomes with the Kerr calcaneal score. There were no wound complications encountered in our series. However, there was one patient with a k-wire broken intraoperative and left in situ and there were two patients with prominent screws. Despite this, our experience with percutaneous fixation of displaced intra-articular calcaneal fractures has been generally favourable, allowing for good outcomes and satisfactory reduction of the fracture fragments.