Open reduction and internal fixation with conventional plate via L-shaped lateral approach versus internal fixation with percutaneous plate via a sinus tarsi approach for calcaneal fractures – A randomized controlled trial

OBJECTIVE: We aimed to compare the clinical outcomes of intra-articular calcaneus fractures treated with open reduction and internal fixation with conventional plate via L-shaped lateral approach (routine treatment) versus those with percutaneous plate via a sinus tarsi approach (minimally invasive treatment). METHODS: One hundred and seventeen displaced intra-articular calcaneal fractures in 108 patients from January 2007 and September 2010 were randomly allocated to receive routine treatment (49 patients) or minimally invasive treatment (59 patients). Operative time, preoperative and postoperative calcaneal height, width, length, Böhlers angle, Gissanes angle, and incision healing were recorded. Maryland foot score system was used to evaluate clinical functional outcomes. RESULTS: The operative time of minimally invasive group was significantly shorter than that of the routine group [46-80 min (mean, 62 min) vs 65-110 min (mean, 93 min), p < 0.01]. Postoperative X-ray showed the calcaneal height, width, length, Böhlers angle and Gissanes angle were significantly improved in both two groups, and no significant difference was observed between two groups postoperatively. No feet developed wound complications in minimally invasive group, but incision complications occurred in 8 feet in routine group. The excellent and good rate according to the Maryland foot score was significantly higher in minimally invasive group than that in the routine group (93.8% vs 86.8%). CONCLUSION: Compared with L-shaped lateral approach treatment of displaced intra-articular calcaneal fractures, sinus tarsi approach for the reduction and internal fixation with percutaneous plate seems to be more safe and effective, with satisfactory clinical therapeutic effects and without postoperative complications.