A prospective comparative study between percutaneous cannulated screws and Kirschner wires in treatment of displaced intra-articular calcaneal fractures,International Orthopaedics

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A prospective comparative study between percutaneous cannulated screws and Kirschner wires in treatment of displaced intra-articular calcaneal fractures
International Orthopaedics ( IF 2.0 ) Pub Date : 2022-08-12 , DOI: 10.1007/s00264-022-05521-y
Hossam El-Azab ₁ , Khalaf Fathy Elsayed Ahmed ₁ , Abdelrahman Hafez Khalefa ₁ , Ashraf Rashad Marzouk ₁

Affiliation

Purpose

Several minimally invasive procedures were used to treat displaced intra-articular calcaneal fractures (DIACFs). No agreement among different authors about either the ideal fixation method or which technique is minimally invasive. The aim of this study was to compare functional and radiographic outcomes of two minimally invasive techniques in treatment of Sanders type II and III DIACFs by using K-wires or cannulated screws without bone grafts.

Methods

A prospective randomized controlled study was conducted on 28 patients (34 feet) with Sanders type II or III DIACFs, treated by closed reduction and fixation using cannulated screws or K-wires, at the Orthopedics Department of Sohag University Hospital, between April 2020 and February 2022. Functional assessment was done by American Orthopedic Foot and Ankle Society (AOFAS) score and VAS for pain. Radiographic assessment was done by measurement of three calcaneal angles (Gissane, Böhler’s, and posterior facet inclination angles) and three calcaneal distances (height, length, and width of the calcaneus).

Results

Mean ages of patients at the time of operation were 34.8 years for the cannulated screw group and 36.6 years for the K-wire group. A vast majority of patients were males (78.6%). Involvement of the right side in the cannulated screw group was 57.1% and that in the K-wire group was 47.9%. Mean operative time was significantly shorter among the K-wire group (42 min) compared to the cannulated screw group (57 min). Mean AOFAS score was higher among the cannulated screw group (85.9 points) compared to the K-wire group (75.8 points). Final VAS was significantly better among the cannulated screw group compared to the K-wire group. Mean time of radiographic union in the cannulated screw group was 8.9 weeks and that in the K-wire group was 10.1 weeks.

Conclusion

Both techniques avoided wound complications associated with ORIF with the advantage of a shorter hospital stay. Patients in the cannulated screw group had better functional and radiographic outcomes and a lower rate of subtalar arthritis than patients in the K-wire group. K-wires had advantages of reduced operative time, and easy removal as an outpatient procedure.

中文翻译：

经皮空心螺钉与克氏针治疗移位的跟骨关节内骨折的前瞻性对比研究

目的

几种微创手术被用于治疗移位的关节内跟骨骨折（DIACFs）。对于理想的固定方法或哪种技术是微创的，不同作者之间没有达成一致意见。本研究的目的是比较两种微创技术在不使用骨移植物的情况下使用克氏针或空心螺钉治疗 Sanders II 型和 III 型 DIACF 的功能和影像学结果。

方法

2020 年 4 月至 2 月期间，在 Sohag 大学医院骨科，对 28 名患有 Sanders II 或 III 型 DIACF 的患者（34 英尺）进行了一项前瞻性随机对照研究，这些患者通过闭合复位和使用空心螺钉或克氏针固定进行治疗2022. 美国骨科足踝协会 (AOFAS) 评分和 VAS 对疼痛进行了功能评估。通过测量三个跟骨角（Gissane、Böhler's 和后小关节倾斜角）和三个跟骨距离（跟骨的高度、长度和宽度）来进行放射影像学评估。

结果

手术时患者的平均年龄为空心螺钉组 34.8 岁和克氏针组 36.6 岁。绝大多数患者是男性（78.6%）。右侧空心螺钉组受累率为 57.1%，克氏针组受累率为 47.9%。与空心螺钉组（57 分钟）相比，克氏针组的平均手术时间（42 分钟）显着缩短。与克氏针组（75.8 分）相比，空心螺钉组的平均 AOFAS 评分（85.9 分）更高。与克氏针组相比，空心螺钉组的最终 VAS 明显更好。空心螺钉组平均影像学愈合时间为8.9周，克氏针组为10.1周。