Journal List > J Korean Fract Soc > v.32(3) > 1130292

Park, Ko, Lee, and Baik: Surgical Treatment for Displaced Intra-Articular Calcaneal Fractures in Elderly Patients – Comparison of the Minimally Invasive Approach and Extensile Lateral Approach –

Abstract

Purpose

As the functional demands for activities in elderly patients are increasing according to their life extension, the need for surgical treatment is also increasing in elderly patients with displaced intra-articular calcaneal fractures. In addition to the extensile lateral approach (ELA), which is a surgical procedure that showed good results on intra-articular calcaneal fractures, the minimally invasive approach (MIA) also showed an outstanding result. This study compared the radiological and clinical results of intra-articular calcaneus fractures in elderly patients in two groups: ELA and MIA.

Materials and Methods

Thirty patients aged over 65 years with intra-articular calcaneus fractures, who could be followed-up more than 14 months, were included in this study. Thirteen patients of the MIA group and 17 patients of the ELA group were analyzed retrospectively using radiological and clinical assessments.

Results

No significant difference in union time, posterior facet reduction accuracy, subtalar osteoarthritis frequency, Bohler angle, calcaneal width, American Orthopaedic Foot and Ankle Society score, visual analogue scale score, 36–item short form survey, and foot function index was observed between the two groups. The p-value of the average height of the calcaneus correction, average length of calcaneal correction, and average loss of correction length were <0.001, 0.005, and 0.015, respectively. The incidence of complications, including soft tissue necrosis and bone infection, were 23.1% in the ELA group and none in the MIA group.

Conclusion

The clinical outcomes were similar in the two groups. The degree of reduction of fracture showed a better result in the MIA group than the ELA group. Furthermore, there were no complications in the MIA group, whereas the ELA group showed some complications.

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Fig. 1.
Minimally invasive approach. (A, C, E) Lateral radiographs of the calcaneus. (B, D, F) Axial radiographs of the calcaneus.
jkfs-32-135f1.tif
Fig. 2.
Extensile lateral approach. (A) Lateral radiograph of the calcaneus. (B) Axial radiograph of the calcaneus.
jkfs-32-135f2.tif
Fig. 3.
(A) Lateral radiograph of the calcaneus shows measurements of the Böhler angle, calcaneal height, calcaneal length. (B) Axial radiograph of the calcaneus shows measurements of the calcaneal width.
jkfs-32-135f3.tif
Table 1.
Comparison of the Demographic Data and Clinical Outcome between the Treatment Groups
Variable Extensile lateral approach (n=13) Minimally invasive approach (n=17) p-value
Mean age (yr) 67.7±2.2 71.4±4.5 0.031
Sex; male/female 12:1 10:7 0.123
BMD (T-score) –1.9±0.6 –2.0±1.6 0.320
Sanders type (II:III) 7:6 10:7 0.837
Union time (wk) 17.0±2.3 16.1±0.6 0.245
Subtalar OA (%) 6 (46.2) 5 (29.4) 0.680
VAS score 20.0±28.6 15.3±16.7 0.869
AOFAS score 90.1±12.4 88.5±9.7 0.432
SF-36 66.0±8.6 70.9±5.2 0.229
FFI 19.5±15.2 17.5±9.2 0.805
Complication 3 (23.1) 0 (0) 0.300

Values are presented as mean±standard deviation, number only, or number (%). BMD: bone mineral density, OA: osteoarthritis, VAS: visual analogue scale, AOFAS score: American Orthopaedic Foot and Ankle Society ankle–hindfoot score, SF-36: 36-item short form survey, FFI: foot function index.

Table 2.
Comparison of the Radiologic Outcomes between the Treatment Groups
Variable Extensile lateral approach (n=13) Minimally invasive approach (n=17) p-value
Posterior facet reduction accuracy (Ana+Near rly) 76.9 94.1 0.432
Böhler angle (°)      
Postop correction 22.3±15.8 19.0±9.6 >0.999
Degree of loss during F/U –4.3±6.0 –6.4±5.0 0.053
Difference from the other side –2.9±7.1 –6.2±6.2 0.113
Height (mm)      
Postop correction 7.4±3.4 1.9±3.5 <0.001
Degree of loss during F/U –3.9±3.2 –2.2±2.2 0.133
Difference from the other side 2.5±2.7 –2.3±2.5 <0.001
Width (mm)      
Postop correction –4.2±4.9 –3.3±2.9 0.363
Degree of loss during F/U –1.0±2.9 0.1±0.5 0.805
Difference from the other side 1.9±3.0 1.0±1.5 0.967
Length (mm)      
Postop correction 3.0±2.1 1.1±1.6 0.005
Degree of loss during F/U –4.4±3.9 –1.4±1.9 0.015
Difference from the other side 0.6±3.1 –1.2±2.0 0.053
Values are presented as percent only or mean±standard deviation. Ana: anatomical, Nearly: nearly anatomical, Postop: postoperative, up. F/U: follow-
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