gms | German Medical Science

Objective: To assess clinical and radiological results in a group of patients with calcaneal fracture, treated by means of minimally invasive, arthroscopically assisted osteosynthesis.

Methods: In period from 1st January 2005 to 31st December 2011, we have treated surgically 230 patients with 260 calcaneal fractures. For prospective follow-up in this part of study, we have included 34 patients with 36 fractures, treated by means of arthroscopically assisted osteosynthesis. In all consecutively included patients, there were recorded basic demographic data, fracture classification (Sanders), time to surgery, quality of reduction, Böhler´s angle before and after surgery, soft tissue complications, final functional score (Rowe) and time of follow-up. This type of surgery was preferred in fracture types Sanders IIa, IIb and surgery was also performed in smokers, diabetic and dialysed patients.

Study population comprised of 28 men with 30 fractures and 6 women with 6 fractures. Eleven men were heavy smokers, six patients were addicted to alcohol. Fracture types according to Sanders classification: 20 type IIa, 12 type IIb, two type IIIab and one type IIIac and IIIbc respectively.

Results: There were neither postoperative soft-tissue complications nor deep infection in this group of patients. According to CT control, fracture reduction was assessed as excellent in 31 fractures, good (step in subtalar joint of 2 milimeters) in 4 fractures and bad (step of 3 mm) in one fracture. Mean pre-surgery Böhler´s angle was +7.2 °, after surgery, it was 35.4 ° (improvement of 28.2 °). Bony healing was achieved in all patients after 3 months. Mean follow-up was 18.5 months. Final functional score according to Rowe was excellent in 22 patients, good in 5 patients and sufficient in 5 patients, we have not seen any bad result. Mean score was 86 points.

Discussion: Compared to grouf of ORIF patients, this group comprises of more cases of "simpler" fracture types. Surgical technique is demanding, learning curve is long. Improvement of Böhler´s angle and quality of reduction is comparable to open techniques. Absence of soft tissue complications and infection is very promising. Very good functional results are in part caused by ###simpler### fracture types.

Conclusion: Final assessment of our group of patients treated by means of minimally invasive arthroscopically assisted osteosynthesis show similar results in terms of fracture reduction and functional results, when compared to open techniques. Achieved full bony healing and absence of soft tissue complications could present a good alternative for patients not suitable for ORIF.