Minimally invasive manipulative reduction with poking k-wire fixation in the treatment of various types of calcaneal fractures

B. Lu, P. Liu, Y. Wang, J.-B. Yuan, X.-M. Tang, D. Wei, B. Zhang, Y.-M. Hu

Department of Orthopedics, Sichuan Provincial People’s Hospital, Sichuan Academy
of Medical Sciences, 32 W 2nd Section, Chengdu, Sichuan, China. onemeihu@163.com

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• Orthopedics

OBJECTIVE: The aim of this study is to investigate the safety and clinical efficacy of minimally invasive manipulative reduction with poking k-wire fixation in the treatment of various types of calcaneal fractures.

PATIENTS AND METHODS: Between July 2012 and July 2014, a prospective parallel controlled study was conducted on 96 patients with closed calcaneal fractures who were admitted to our institution. These patients were randomly divided into two groups, with 48 in each group. Patients in plate group were treated using open reduction and internal fixation, whereas those of manipulation group were treated with minimally invasive manipulative reduction with poking k-wire fixation. All patients were followed up for six months to assess the postoperative recovery and complications. Kerr’s scale was adopted to evaluate the functional recovery of fractured calcaneus.

RESULTS: A mean healing duration of 9.48 ± 1.92 weeks was achieved in patients of plate group compared with a healing duration of 9.35 ± 1.66 weeks in those of manipulation group, with no statistical significance (p > 0.05). Complications occurred in 20 cases in plate group versus in seven cases in manipulation group with significant difference (p < 0.05). As for Sanders type II fracture, among patients with compression fracture and tongue type fracture, > 70% of patients achieved with excellent and good outcomes in both groups with no significant difference in clinical efficacy (p > 0.05). The rate of excellent and good outcomes in Sanders type III compression fractures was lower in manipulation group than in plate group (p < 0.05). As for Sanders type II fractures, the Kerr’s score of tongue type fractures in manipulation group was higher than that in plate group, and comparison within manipulation group showed that the score of tongue type fractures was significantly higher than that of compression fractures (p < 0.05). However, as for Sanders type III fractures, the score of tongue type fractures in manipulation group was significantly higher than that in plate group, and the score of compression fractures in plate group was significantly higher than that in manipulation group (p < 0.05).

CONCLUSIONS: Minimally invasive manipulative reduction with poking k-wire fixation is suitable for the treatment of Sanders type II tongue type and compression calcaneal fractures, as well as the treatment of Sanders type III tongue type fractures with several advantages, including easy operation, lower cost, fewer complications and favorable recovery.

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