Operative treatment of tongue type fractures of the calcaneus: comparison of clinical results between open and percutaneous techniques

Abstract

Objective: To realize a case-control study, comparing the clinical outcomes of tongue fractures of the calcaneus treated by two techniques: open reduction and internal fixation or percutaneous fixation. Methods: Between January 2005 and December 2007, 15 patients were treated by the percutaneous reduction and fixation (Group A). These patients were compared to other 15, treated by open reduction and internal fixation with plate (Group B). The groups were similar in age, sex, side of fracture, type of fracture, initial displace and initime between the injury and the surgery. Results: Minimal follow-up was ten months. More early (p=0.005) and late (p=0.004) complications occurred in Group B. There were more patients with AOFAS score considered good/excellent (>80) in the Group A than in the Group B, but with no statistical significance (p=0.2557). The mean AOFAS score of Group A was slightly better than Group B, but with no statistical significance too (p=0.1224). When the groups were separated by the postoperative Böhler angle, in both groups patients with Böhler angle >20º had a mean AOFAS score statistically better (p=0.0002). Regrouping all 30 patients in one group, the mean AOFAS score of the 22 patients with Böhler >20º also was statistically better than the mean AOFAS of the 8 patients with that angle Conclusions: The percutaneous approach results in clinical outcomes similar to those of open reduction and internal fixation with a plate, but with less early and late postoperative complications. In this study, the most important factor for good outcome was not the surgical technique but the quality of postoperative reduction, with better evolution for patients with a Böhler angle >20º.