Comparing small locking plate fixation versus small locking plate with screws fixation of displaced intra-articular calcaneus fracture via sinus tarsi approach

doi:10.21203/rs.3.rs-2457697/v1

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Comparing small locking plate fixation versus small locking plate with screws fixation of displaced intra-articular calcaneus fracture via sinus tarsi approach

https://doi.org/10.21203/rs.3.rs-2457697/v1

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Background

The purpose of this study was to compare the clinical and radiological outcomes of displaced intra-articular calcaneus fractures (DIACFs) treated with small locking plates alone versus small locking plates combined with screws.

Methods

Retrospective analysis of 120 patients with intra-articular fractures seen from May 2018 to June 2020, all of whom were surgically repositioned using sinus tarsal approach.60 cases received a small locking plate combined with screws fixation (observation group) and 60 cases received a small locking plate fixation alone (control group).Demographic variables were recorded and compared Gissane angle, Bohler's angle, calcaneal varus, and joint line parallel angle at 3 days and 2 years postoperative follow-up.The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot Score and VAS were applied to assess postoperative foot function, and complications were also compared.

Results

Compared with the control group, the joint line parallel angle and calcaneal varus in the observation group had lower displacement changes from the postoperative period to the 2-year follow-up,they are 0.07 (0.15) degrees vs 0.47 (0.59) degrees(P < 0.001), 0.19 (0.35) degrees vs 1.18 (0.67) degrees(P < 0.001).There was no significant difference in Gissane angle and Bohler's angle between the observation group and the control group at the preoperative, 3-year and 2-year follow-up (P > 0.05).The final AOFAS score, VAS score and complications were not significantly different between the two groups (P > 0.05).

Conclusion

When STA is used to treat DIACFs, fixation with a small locking plate combined with screws appears to provide better posterior articular surface stability and better maintenance of calcaneal axial stability than fixation with a small locking plate alone,the two techniques had similar functional outcomes and complications after surgery.

Sinus tarsi incision

Small locking plate

Hollow screw

Internal fixation

Calcaneal fracture is a clinically common lower limb fracture,approximately 60% of all tarsal fractures were calcaneal fractures, and approximately 75% of calcaneal fractures were DIACFs[1, 2].Because calcaneal fracture is more common in high fall injury, the high impact of the heel is often easy to involve the articular surface, resulting in intraarticular fracture.Severe trauma or improper treatment may result in peroneal tendon dislocation, subtalar joint arthritis, achilles tendon weakness, etc.For DIACFs, surgical treatment is more effective and satisfactory than conservative treatment[3, 4].

The Open Reduction and Internal Fixation (ORIF) helps restore joint function and reduces the risk of late subtalar fusion[5, 6],The extensile lateral approach (ELA) can fully expose the fracture line of the subtalar articular surface and allow direct reduction.However, the incidence of wound complications has been reported to range from 13.3–29%[7–9].In recent years, the small-incision approach has attracted more attention because of its small wound and few complications,and sinus tarsi approach (STA) can effectively restores anatomical structure and significantly reduces soft tissue complications[10].STA can directly expose and restore the subtalar articular surface, and can be used for most DIACFs[11].

Several studies have described similar early fracture recovery and good functional outcomes with plate and screw by STA[12, 13], Chotikkakamthorn et al [14] reported that screw combined small locking plate could obtain better stability of posterior articular surface and calcaneal axis than screw alone。It is not clear what is the difference in clinical and imaging outcomes between small locking plates and small locking plates combined with screws.Therefore, we studied these two methods and compared their clinical efficacy and complications.

Patient populations

From May 2018 to June 2020, a total of 120 cases underwent STA surgery to treat DIACFs.All operations were performed by the same surgeon.The inclusion criteria were as follows: 1)age ≥ 18 years;2)closed fracture༛3)no other medical conditions affecting the operation。The exclusion criteria were as follows༚1)open fracture༛②age < 18 years༛③concomitant diabetes༛④vascular disease was present in the affected limb.120 cases were included,60 cases were treated with small locking plate combined with hollow screws by STA (observation group),60 cases were treated with small locking plate by STA (control group).This retrospective cohort study was approved by the Medical Ethics Committee of Fuzhou Second Hospital(Ethical NO. 2022–205),and obtained informed consent from eligible patients.

Demographic data of all patients were collected, including gender, age, BMI, surgical side, waiting time, surgical time, follow-up time, and Sanders classification.In the observation group, there were 49 males and 11 females; the age was 48.6 ± 12.4 years old; the mean follow-up time was 42.1 ± 3.2 months. In the control group, there were 46 males and 14 females; the age was 47.4 ± 10.1 years old; the mean follow-up time was 41.5 ± 3.6 months.The demographics of these two groups are shown in Table 1.

Table 1

Comparison of general data between the two groups
Factors	Observation group(N = 60)	Control group(N = 60)	p-value
Age (years)	48.6 ± 12.4	47.4 ± 10.1	0.626
Mean follow-up time (month)	42.1 ± 3.2	41.5 ± 3.6	0.386
Average waiting time (days)	6.2 ± 2.6	7.1 ± 3.4	0.307
Operation time (minutes)	62.8 ± 18.6	60.6 ± 16.4	0.564
BMI			0.309
Underweight(༜18.50kg/m²)	5	7
Normal (18.50−24.99kg/m²)	28	31
Overweight(25.00−29.99kg/m²)	24	20
Obesity(≥30.00kg/m²)	3	2
Sex			0.500
Male	49	46
Female	11	14
Side of injured			0.353
Right	38	33
Left	22	27
Sanders classification			0.130
Type II	24	35
Type III	31	22
Type IV	5	3

Preoperative management

Lateral and axial calcaneal radiographs of the injured foot and three-dimensional CT reconstruction were used in all patients to assess calcaneal fracture morphology and articular surface collapse.After the injury, the limb is immobilized and elevated in a cast and iced with an ice pack until the swelling of the foot subsides and skin wrinkles appear.

Surgical techniques

General anesthesia was used to take the healthy lateral decubitus position and pneumatic tourniquet was applied to the affected lower limb, a 6cm long tarsal sinus incision was made from the lower tip of the outer ankle tip through the tarsal sinus to the proximal end of the dice bone.The subcutaneous tissue is bluntly separated, the peroneal tendon is exposed and pulled backward and downward,the calcaneofibular Ligament is partially severed at the insertion of the calcaneus.After the removal of the subtalar articular surface clot and part of the embedded soft tissue, the fracture can be clearly exposed,the calcaneal deformity was corrected by traction, prying and other methods under the perspective of C-arm machine.Allograft bone can be implanted for patients with more bone defects.(Figure 3)

Observation group: A small locking plate is placed under the subtalar joint to support the joint surface after fluoroscopic examination and normal repositioning.A longitudinal incision about 1cm long was made at the center and bottom of the calcaneal tubercle, and a 6.5mm hollow screw was inserted along the long axis of the calcaneal bone from the central incision to maintain the length of the calcaneal bone and a 4.5mm hollow screw was inserted from the bottom incision along the posterior articular surface of the calcaneus to maintain the height of the calcaneus.The fracture was again confirmed to be in a good position under C-arm fluoroscopy. The incision was rinsed and sutured in layers, and the incision was bandaged with pressure. No drainage tube was placed in the incision. (Fig. 4)

Control group: A small locking plate is placed under the subtalar joint to support the joint surface after fluoroscopic examination and normal repositioning, the fracture was again confirmed to be in a good position under C-arm fluoroscopy. The incision was rinsed and sutured in layers, and the incision was bandaged with pressure. No drainage tube was placed in the incision.(Fig. 5)

Postoperative management

Patients in both groups had their affected limbs elevated postoperatively,active and passive toe and ankle flexion and extension exercises were started on the second postoperative day,partial weight-bearing training was started 4 weeks after surgery and full weight-bearing training was started at 3 months after surgery.

Radiological evaluation

Preoperative CT scan was performed to confirm Sanders classification.Lateral and axial radiographs were performed to study Gissane angle, Bohler's angle, calcaneal varus, and joint line parallel angle.Radiological assessments were performed before surgery, 3 days after surgery, and 2 years after surgery.Joint line parallel angle and calcaneal varus were evaluated by using the methods of Chotikkakamthorn and Harnroongroj et al. [14, 15] (Figs. 1 and 2).

Clinical evaluation

Clinical outcomes were evaluated by using the Visual Analog Scale (VAS) and the American Orthopaedic Foot and Ankle Association (AOFAS) ankle and posterior foot scoring system.These scores were evaluated at 1, 3, 6, 12 months and 2 years after surgery.The AOFAS scoring system ranges from 0 to 100, with higher scores indicating better ankle function, 90 to 100 are excellent, 75 to 89 are good, 50 to 74 are fair, and below 50 are poor.The VAS pain scoring system is used to assess pain on a scale from 0 to 10, with higher scores indicating higher levels of pain.Postoperative complications, such as peroneal nerve injury, screw irritation, and degenerative changes of subtalar joint, were evaluated through regular follow-up visits.

Statistical analysis

SPSS23.0 statistical software was used for data analysis, measurement data were expressed as mean ± standard deviation, and independent sample t test was used for comparison between groups;Chi-square test and rank sum test were used to compare the counting data groups.Due to the non-normal distribution, imaging findings were compared using the Mann-Whitney U test, expressed as median and quartile ranges (IQR).Pearson's chi-square test was used to determine the significance of differences between groups on the incidence of complications. Test standard is a = 0.05.

Clinical outcomes

As shown in Table 2, the mean AOFAS score was 85.9 ± 3.8 in the small locking plate combined screws group at 3 months postoperatively and 88 ± 3.5 at the last follow-up, there were 15 cases (25%) of excellent cases, 37 cases (70%) of good cases, and 3 cases (5%) of average cases. The excellent/good rate was 95%.the mean AOFAS score was 84.8 ± 2.3 in the small locking plate group at 3 months postoperatively and 87.6 ± 2.3 at the last follow-up, there were 12 cases (20%) of excellent cases,46 cases (76.7%) of good cases, and 2 cases (3.3%) of average cases. The excellent/good rate was 96.7%.The VAS score 3 months after surgery was 2.4 ± 0.9 in the small locking plate combined with screws group and 2.3 ± 0.8 in the small locking plate group.At the last follow-up, the results were 1.7 ± 0.8 for the small locking plate combined with screws group and 1.7 ± 0.8 for the small locking plate group。There were no significant differences in these scores between the two groups (P > 0.05).

Table 2

Results of different functional scoring systems for the two groups
		Observation group(N = 60)	Control group(N = 60)	p-value
Three-months post-operative	AOFAS	85.90 ± 3.88	84.83 ± 2.38	0.130
	VAS	2.40 ± 0.93	2.34 ± 0.89	0.779
Final follow-up	AOFAS	88.02 ± 3.50	87.69 ± 2.35	0.615
	VAS	1.72 ± 0.89	1.78 ± 0.87	0.788

Radiographic outcomes

As shown in Table 3, there was no significant difference in Bohler's angle and Gissane angle between the two groups during the preoperative, postoperative and follow-up periods (P > 0.05).Only the small locking plate group had a statistically significant increase in calcaneal varus, joint line parallel angle at the 2-year postoperative follow-up (P < 0.05).

Table 3

**Radiographic results for the two groups**
Factors	Observation group(N = 60)	Control group(N = 60)	p-value
Pre-operative Bohler’s angle (degrees)	12.59(9.32)	8.38(24.92)	0.135
3-day post-operative Bohler’s angle (degrees)	21.67(10.25)	26.54(11.64)	0.111
2-Year post-operative Bohler’s angle (degrees)	21.38(10.31)	26.87(11.88)	0.110
Change in Bohler’s angle (degrees)	−0.04(0.64)	−0.12(0.58)	0.538
Pre-operative Gissane angle (degrees)	91.79(8.10)	90.26(14.28)	0.233
3-day post-operative Gissane angle (degrees)	109.65(11.18)	104.71(18.17)	0.117
2-Year post-operative Gissane angle (degrees)	107.22(13.38)	105.13(17.33)	0.689
Change in Gissane angle (degrees)	−0.11(1.78)	0.32(0.41)	0.320
Pre-operative calcaneal varus (degrees)	12.44(7.21)	11.52(7.58)	0.636
3-day post-operative calcaneal varus (degrees)	3.06(1.69)	2.71(2.84)	0.152
2-Year post-operative calcaneal varus (degrees)	3.54(1.60)	4.26(2.35)	0.574
Change in calcaneal varus (degrees)	0.19(0.35)	1.18(0.67)	＜0.001
Pre-operative joint line parallel angle (degrees)	14.67(8.41)	16.38(9.62)	0.137
3-day post-operative joint line parallel angle (degrees)	3.55(3.20)	2.88(1.94)	0.113
2-Year post-operative joint line parallel angle (degrees)	3.67(2.41)	3.32(2.08)	0.979
Change in joint line parallel angle (degrees)	0.07(0.15)	0.47(0.59)	＜0.001

Complications

As shown in Table 4, no complications of wound nonunion or fracture nonunion occurred in two groups.In the small locking plate combined with screws group, there were 5 complications, of which 2 were screw stimulation, 2 were sural nerve injury, and 1 was subtalar joint degeneration.There were 3 complications in the small locking plate group, including 1 sural nerve injury and 2 subtalar joint degeneration.The complication rate was 8.3% in the small locking plate combined with screws group and 5% in the small locking plate group (P > 0.05).

Table 4

Comparison of the postoperative wound-related complications in the two groups
	Observation group(N = 60)	Control group(N = 60)	p-value
Wound complication	5(8.3%)	3(5.0%)	0.315
Sural nerve injury	2(3.3%)	1(1.7%)
Screw stimulation	2(3.3%)	0
Subtalar joint degeneration	1(1.7%)	2(3.3%)

The results of DIACFs fixation with small locking plate combined with screw and small locking plate alone were compared in this study.Compared with preoperative measurements, Bohler's angle, Gissane angle, calcaneal varus and joint line parallel angle were significantly recovered in both groups.In addition, immediate and 2-year follow-up X-rays were further compared,the small locking plate fixation group showed statistically significant differences in the increase of calcaneal varus and joint line parallel angle,this indicated that the small locking plate fixation group had worse stability in axial fixation and posterior articular surface.Wang et al[16] reported that locking plates could provide better support and maintain long-term fixation of the fracture mass compared with screws alone.Chotikkakamthorn et al[14] described that a locking plate combined with a single screw could provide better posterior articular surface stability when fixing calcaneal fracture blocks, This study further compared the difference between locking plate combined with screws and locking plate alone in maintaining bone stability.In our practice, plate combined screws provide similar reduction results as simple plate,However, the long-term joint line parallel angle and calcaneal varus increased significantly when the plate was used alone,this indicates that the plate combined with screws provides a more stable fixing effect, especially in the posterior articular surface and axial aspect.We believe that two screws in different directions on the axis provide better stability, Moreover, a screw to fix the posterior articular surface can assist the plate to strengthen the support of the posterior articular surface, which is consistent with our findings.

Previous studies have demonstrated that hollow screws have similar fixation functions to the plates [17, 18],Ni et al[19] described that adequate stability could be provided through the cross-screw technique,another study showed that longitudinal screw bear major stresses in standing position [20].Lv et al [21] described a double-point fixation (DPF). Fixation of the posterior subtalar joint and calcaneal tuberculum can reduce the change in posterior articular surface displacement.Simon et al[22] achieved good results by fixing DIACFs with a locking screw that fixed the posterior subtalar joint and calcaneal tubercles.The above studies have demonstrated the reliability of DPF in fixed subtalar joint and the good clinical results can be achieved, However, there are no systematic studies to guide the use of hollow screws,in order to provide better stability of the posterior articular surface and maintain the axial shape of the calcaneus, we recommend the use of hollow screw assisted plate fixation in the case of severe calcaneal varus and posterior articular surface collapse.Protruding screws are an important reason for secondary surgery [23].In order to avoid screw irritation, the hollow screws should be embedded into the bone surface.

One study reported that one-third of patients in the hollow-screw fixation group had poor long-term functional outcomes [24],Some literatures reported that the final functional outcome of most patients in the plate group was good [25, 26].Our results showed no significant difference in final AOFAS and VAS scores between the plate combined with screws and the plate group, suggesting that the two surgical methods for calcaneal fracture are similar in ankle function.

The incidence of subtalar arthritis in patients with different percutaneous screw fixation has been reported in the literature, ranging from 15–24%[27, 28].In this study, there was one subtalar joint degeneration in the plate combined screw group (1.6%), compared with 3.2% in the plate group.However, due to the small sample size of these studies, they cannot be used for clinical guidance.The effect of different surgical methods on subtalar arthritis needs further research.The study of Fan et al [26] showed that the incidence of wound infection, wound nonunion and other complications in the plate fixation group was higher than that in the hollow screw group.Another study showed that the incidence of postoperative implant irritation in the plate combined screw group was higher than that in the hollow screw group [14], and the increase of implants may increase patients' discomfort.

To date, this is the first study to compare imaging and clinical outcomes of the plate combined screws fixation and the plate fixation alone. However, the study has some limitations.First, the follow-up time was relatively short, and ankle complications could not be tracked over a long period of time;Second, this was not a randomized controlled study;Third, the sample size of this study is small, and a larger sample follow-up study is needed.

In summary, when STA is used to treat DIACFs, fixation with a small locking plate combined with screws seems to provide better posterior articular surface stability and better maintenance of calcaneal axial stability than fixation with a small locking plate alone,the two techniques had similar functional outcomes and complications after surgery.

DIACFs:Displaced Intra-articular Calcaneus Fractures

AOFAS:American Orthopaedic Foot and Ankle Society

VAS:Visual Analog Scale

ORIF:Open Reduction and Internal Fixation

STA:Sinus tarsi approach

DPF:Double Point Fixation

Ethics declarations

Ethics approval and consent to participate

The study was approved by the Ethics Committee of Fuzhou Second Hospital (Ethical NO. 2022–205), and was performed in accordance with the ethical standards of the Declaration of Helsinki of 1964.Informed consent was obtained in written form from all eligible patients.

Consent for publication

Not applicable.

Availability of data and materials

The datasets supporting the conclusions of this article are included within the article.

Competing interests

The authors declare that they have no competing interest

Funding

This work was supported by Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma (grant numbers 2020Y2014).

Authors’ contributions

WHZ is responsible for the design; WHZ and WHY wrote the paper. WHY was responsible for statistical processing; XG and JFL to provide technical support; ZSH and ZLL participated in the formation of viewpoints; BL, DL participated in the collection of clinical data. The authors read and approved the final manuscript.

Acknowledgements

Not applicable.

Author information

Authors and Affiliations

Department of Orthopaedic Surgery, Fuzhou Second Hospital, NO. 47, Shang Teng Road, Cangshan District, Fuzhou, Fujian Province, 350000, China

Wenhan Zhao,Weihua Yang,Xi Gao, Zhanglai Li, Jinfu Lan, Bei Lin,Deng Liang,Zhusong Huang.

Corresponding author

Correspondence to Zhusong Huang.

Palmersheim K, Hines B, Olsen BL. Calcaneal fractures: update on current treatments. Clin Podiatr Med Surg. 2012 Apr;29(2):205-20, vii. doi: 10.1016/j.cpm.2012.01.007. PMID: 22424485.
Bajammal S, Tornetta P 3rd, Sanders D, Bhandari M. Displaced intra-articular calcaneal fractures. J Orthop Trauma. 2005 May-Jun;19(5):360-4. PMID: 15891550.
Shi F, Wu S, Cai W, Zhao Y. Comparison of 5 Treatment Approaches for Displaced Intra-articular Calcaneal Fractures: A Systematic Review and Bayesian Network Meta-Analysis. J Foot Ankle Surg. 2020 Nov-Dec;59(6):1254-1264. doi: 10.1053/j.jfas.2020.03.021. Epub 2020 Aug 20. PMID: 32828631.
Buckley R, Tough S, McCormack R, et al. Operative compared with nonoperative treatment of displaced intra-articular calcaneal fractures: a prospective, randomized, controlled multicenter trial. J Bone Joint Surg Am. 2002;84(10):1733-1744. doi:10.2106/00004623-200210000-00001
Csizy M, Buckley R, Tough S, et al. Displaced intra-articular calcaneal fractures: variables predicting late subtalar fusion. J Orthop Trauma. 2003;17(2):106-112. doi:10.1097/00005131-200302000-00005
Selim A, Ponugoti N, Chandrashekar S. Systematic Review of Operative vs Nonoperative Treatment of Displaced Intraarticular Calcaneal Fractures. Foot Ankle Orthop. 2022;7(2):24730114221101609. Published 2022 May 26. doi:10.1177/24730114221101609
Yeo JH, Cho HJ, Lee KB. Comparison of two surgical approaches for displaced intra-articular calcaneal fractures: sinus tarsi versus extensile lateral approach. BMC Musculoskelet Disord. 2015;16:63. Published 2015 Mar 19. doi:10.1186/s12891-015-0519-0
Folk JW, Starr AJ, Early JS. Early wound complications of operative treatment of calcaneus fractures: analysis of 190 fractures. J Orthop Trauma. 1999;13(5):369-372. doi:10.1097/00005131-199906000-00008
Kline AJ, Anderson RB, Davis WH, Jones CP, Cohen BE. Minimally invasive technique versus an extensile lateral approach for intra-articular calcaneal fractures. Foot Ankle Int. 2013;34(6):773-780. doi:10.1177/1071100713477607
Zhou HC, Yu T, Ren HY, et al. Clinical Comparison of Extensile Lateral Approach and Sinus Tarsi Approach Combined with Medial Distraction Technique for Intra-Articular Calcaneal Fractures. Orthop Surg. 2017;9(1):77-85. doi:10.1111/os.12310
Rammelt S, Swords MP. Calcaneal Fractures-Which Approach for Which Fracture?. Orthop Clin North Am. 2021;52(4):433-450. doi:10.1016/j.ocl.2021.05.012
Pitts CC, Almaguer A, Wilson JT, Quade JH, Johnson MD. Radiographic and Postoperative Outcomes of Plate Versus Screw Constructs in Open Reduction and Internal Fixation of Calcaneus Fractures via the Sinus Tarsi. Foot Ankle Int. 2019;40(8):929-935. doi:10.1177/1071100719848063
Guo C, Xu Y, Li C, et al. Comparing less invasive plate fixation versus screw fixation of displaced intra-articular calcaneus fracture via sinus tarsi approach. Int Orthop. 2021;45(9):2231-2237. doi:10.1007/s00264-020-04867-5
Chotikkakamthorn N, Chanajit A, Tharmviboonsri T, Chuckpaiwong B, Harnroongroj T. Minimal invasive surgery in the management of intra-articular calcaneal fractures: A retrospective comparison of screw fixation alone versus screw with small locking plate fixation techniques. Acta Orthop Traumatol Turc. 2021;55(3):258-264. doi:10.5152/j.aott.2021.20003
Harnroongroj T, Tangmanasakul A, Choursamran N, Sudjai N, Harnroongroj T. Measurement technique of calcaneal varus from axial view radiograph. Indian J Orthop. 2015;49(2):223-226. doi:10.4103/0019-5413.152489
Wang L, Ye RQ, Wang M. Zhongguo Gu Shang. 2019;32(4):314-320. doi:10.3969/j.issn.1003-0034.2019.04.005
Wang Q, Zhang N, Guo W, Wang W, Zhang Q. Cannulated screw fixation versus plate fixation in treating displaced intra-articular calcaneus fractures: a systematic review and meta-analysis. Int Orthop. 2021;45(9):2411-2421. doi:10.1007/s00264-021-05141-y
Feng Y, Shui X, Wang J, et al. Comparison of percutaneous cannulated screw fixation and calcium sulfate cement grafting versus minimally invasive sinus tarsi approach and plate fixation for displaced intra-articular calcaneal fractures: a prospective randomized controlled trial. BMC Musculoskelet Disord. 2016;17:288. Published 2016 Jul 15. doi:10.1186/s12891-016-1122-8
Ni M, Wong DW, Mei J, Niu W, Zhang M. Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures. Sci China Life Sci. 2016;59(9):958-964. doi:10.1007/s11427-016-0010-9
Zhang H, Lv ML, Liu Y, et al. Biomechanical analysis of minimally invasive crossing screw fixation for calcaneal fractures: Implications to early weight-bearing rehabilitation. Clin Biomech (Bristol, Avon). 2020;80:105143. doi:10.1016/j.clinbiomech.2020.105143
Lv ML, Ni M, Sun W, et al. Biomechanical Analysis of a Novel Double-Point Fixation Method for Displaced Intra-Articular Calcaneal Fractures. Front Bioeng Biotechnol. 2022;10:791554. Published 2022 Mar 9. doi:10.3389/fbioe.2022.791554
Simon P, Goldzak M, Eschler A, Mittlmeier T. Reduction and internal fixation of displaced intra-articular calcaneal fractures with a locking nail: a prospective study of sixty nine cases. Int Orthop. 2015;39(10):2061-2067. doi:10.1007/s00264-015-2816-5
Grün W, Molund M, Nilsen F, Stødle AH. Results After Percutaneous and Arthroscopically Assisted Osteosynthesis of Calcaneal Fractures. Foot Ankle Int. 2020;41(6):689-697. doi:10.1177/1071100720914856
Driessen M, Edwards M, Biert J, Hermans E. Long-term results of displaced intra-articular calcaneal fractures treated with minimal invasive surgery using percutaneous screw fixation. Injury. 2021;52(4):1054-1059. doi:10.1016/j.injury.2020.12.003
Santosha, Gulrez S, Singh AM, et al. Open Reduction and Internal Fixation of Displaced Calcaneum, Intra-Articular Fractures by Locking Calcaneal Plate. J Clin Diagn Res. 2016;10(12):RC18-RC21. doi:10.7860/JCDR/2016/22332.9051
Fan B, Zhou X, Wei Z, et al. Cannulated screw fixation and plate fixation for displaced intra-articular calcaneus fracture: A meta-analysis of randomized controlled trials. Int J Surg. 2016;34:64-72. doi:10.1016/j.ijsu.2016.08.234
Schepers T, Schipper IB, Vogels LM, et al. Percutaneous treatment of displaced intra-articular calcaneal fractures. J Orthop Sci. 2007;12(1):22-27. doi:10.1007/s00776-006-1076-z
Steelman K, Bolz N, Feria-Arias E, Meehan R. Evaluation of patient outcomes after operative treatment of intra-articular calcaneus fractures. SICOT J. 2021;7:65. doi:10.1051/sicotj/2021065

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Comparing small locking plate fixation versus small locking plate with screws fixation of displaced intra-articular calcaneus fracture via sinus tarsi approach

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Background

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Preoperative management

Surgical techniques

Postoperative management

Radiological evaluation

Clinical evaluation

Statistical analysis

Results

Clinical outcomes

Radiographic outcomes

Complications

Discussion

Conclusions

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