Percutaneous and arthroscopically assisted calcaneal osteosynthesis showed good outcomes
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Percutaneous and arthroscopically assisted calcaneal osteosynthesis of calcaneal fractures had “good clinical outcomes” with little risk of infection or complications, according to published results.
Researchers at the University of Oslo analyzed 25 patients with calcaneal fractures treated with percutaneous and arthroscopically assisted calcaneal osteosynthesis (PACO) for a median follow-up of 15 months. Investigators used the Manchester-Oxford Foot Questionnaire (MOxFQ), the calcaneus fracture scoring system (CFSS), the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot score, SF-36 and VAS to determine outcomes. They also assessed the number of complications.
Postoperative radiographic data showed substantial reduction of the fractures with no wound healing complications or surgical site infections, according to the study.
“The median MOxFQ score was 26.6, the CFSS score 85 and the AOFAS score 85. The VAS pain score was 0 at rest and 4.1 during activity,” the researchers wrote.
“We consider PACO to be a promising operative technique for selected calcaneal fractures,” they concluded. “It combines the advantages of a percutaneous approach, reducing the complication risk, with the advantages of arthroscopy, providing full visualization of the posterior facet of the subtalar joint.”
Perspective
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Joan R. Williams, MD
I read the study by Grun and colleagues with great interest. As the authors state, calcaneal fractures continue to be one of the more challenging injuries to treat due, in part, to high rates of infection and soft tissue complications associated with the traditional extensile lateral approach. These fractures can also be quite complex and often successful reduction and fixation comes with a steep learning curve. Because of the high rate of soft tissue complications, there have been many recent studies evaluating less invasive techniques for fixation and this recent study shows good results with subtalar arthroscopy and percutaneous fixation.
Perhaps the most important key to being successful with these less invasive techniques is choosing the correct fracture pattern for them. As the authors state, ensuring you have a large enough sustentacular and tuberosity fragment to allow the percutaneous reduction maneuvers and support the implants is essential. This article shows a viable alternative to the extensile lateral exposure with good results, and I look forward to further larger studies utilizing this technique.
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