Internal fixation with dual incisions and mini plates for calcaneal fractures of Sanders type III

Objective To evaluate the internal fixation with dual incisions and mini plates for cal-caneal fractures of Sanders type Ⅲ. Methods We treated 23 patients with closed calcaneal fracture of Sanders type Ⅲ between May 2012 and May 2014. They were 17 men and 6 women, aged from 20 to 62 years (average, 39.8 years). All of them underwent internal fixation with dual incisions and mini plates. X-ray examinations and CT scans were performed before and after surgery and at the final follow-up to evaluate the height, length and width of the calcaneal joint surface, Bohler angle, Gissane angle and the joint surface step. Complications and American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score were also recorded. Results Of this series, 20 patients completed a follow-up of 18 to 30 months (average, 21.5 months). Delayed wound healing of the medial incision occurred in one case, sural nerve impairment in one, and impairment of tibial nerve branch in 2. No superficial or deep wound infection was noted. Loss of re-duction happened in only one case due to too early weight bearing. Bone union was achieved after an average of 11.3 weeks (from 10 to 12 weeks). The mean Bohler angle (28.3°±10.1°), Gissane angle (120.4°±4.9°), calcaneal width (40.3±9.8 mm), calcaneal height (44.8±3.8 mm) at the final follow-up were significantly improved compared with the preoperative values (-18.2°±18.2°, 97.1°±14.1°, 53.1±10.0 mm, and 31.5±6.1 mm, respectively) (P 0.05). The joint surface step was significantly improved from the preoperative 5.8±3.1 mm to 0.5±0.7 mm (t=7.557, P<0.01). The AOFAS scores averaged 82.9 points (from 45 to 95 points), resulting in 5 excellent cases, 9 good ones, 5 fair ones and one poor case. Signs of traumatic arthritis were observed in 6 cases. Conclusion Internal fixation with dual incisions and mini plates is an effective treatment for calcaneal fractures of Sanders type Ⅲ, because it leads to satisfactory reduction, stable fixation, and limited soft tissue complications. Key words: Calcaneus; Fractures, bone; Fracture fixation, internal; Bone plating