In this study, the objective is to investigate the outcome of percutaneous fixation of displaced calcaneal fractures with cannulated cancellous screws .
Calcaneus fractures are the most common of all tarsal fractures (60%) and account for almost 2% of all adult fractures.Many calcaneal fractures are work-related as they result from a fall from height, especially in males' age 35-45 years .
These fractures often resulted in long-term disability with potentially severe economic impact on the patient. Operative treatment of displaced calcaneal fractures has been controversial due to tissue condition and wound infection.
Historically, most fractures were treated nonoperatively because open reduction and internal fixation were associated with high complication rates and did not result in significantly improved outcomes.
A retrospective review of 14 patients with 16 calcaneal fractures who had percutaneous reduction and screw fixation for displaced fracture of calcaneus was done. The patients were assessed with plain radiography .
In developing countries like India, cost of medical treatment is often a concern, so computed tomography was not done as most of the patients were poor and did not afford the treatment.
The fractures were classified according to Essex-Lopresti classification system. Functional assessment involved in the use of calcaneal fracture scoring system of Kerr et al . and the Maryland foot scoring.
The age of the patients ranged from 23 to 62 years (mean: 34 years). Time to union averaged 13 weeks (range 11-16). The treatment outcome as measured by calcaneal fracture scoring system ranged from 63 to 94 (mean 79).
The mean calcaneal fracture score was 87 (72-91 / 100) for the tongue-shaped group and 73 (52-83 / 100) for the joint depression group ( P = 0.0034).
The mean Maryland foot score was 73/100, with 86% of patients achieving fair to excellent results. The mean functional score was 83 (42-91 / 100) for the tongue-shaped group and 61 (52-73 / 100) for the joint depression group ( P = 0.002).
These results are in concordance with the classical work by Essex-Lopresti who suggested that tongue-type fractures should be managed by percutaneous techniques and joint depression-type fractures require open reduction.
In Conclusion: Percutaneous fixation of fracture calcaneum, offers the prospect of different complications and better outcome, especially in Essex-Lopresti tongue-type fracture .