Which Intra-articular Calcaneal Fracture Treatment Is Safer?

These types of fractures are often caused by a fall from a height where one or both heels directly hit the ground. Displaced intra-articular calcaneal fracture can be complex, highly disabling injuries and there is a lot of debate about the best way to treat them.

Treating displaced intra-articular calcaneal fractures percutaneously reduces complication rates, according to a new study.

The study, “Complications in the Management of Displaced Intra-articular Calcaneal Fractures: A Systematic Review and Network Met-analysis of 2,538 Patients,” was published online on July 13, 2023 in The Journal of Foot & Ankle Surgery.

The researchers compared the complication risk of different treatments for displaced intra-articular calcaneal fracture in randomized controlled trials—including interventions with conservative treatment, surgery with a minimally invasive approach (sinus tarsi or small longitudinal), surgery with a percutaneous approach, and open surgery with the extensive “L” approach.

They also assessed complications and wound infections. The analysis included 26 published trials with a total of 2,538 patients.

For total complications, the mean incidence rate in the extensive “L” approach (ELA) was significantly higher than the rates in other treatments (Conservative Treatment vs. ELA: odds ratio, 0.36; p < 0.001. MIA vs. ELA: OR, 0.23; p = 0.002 and percutaneous approach vs. ELA: OR, 0.18; p < 0.001).

There were no significant differences between the groups when it came to wound infections. And according to the area under the cumulative ranking curve, the percutaneous approach was most likely to be the best approach for reducing the risk of complications.

Of all the approaches, ELA had the highest risk of complications.

“The percutaneous approach was most likely to be the ideal choice when only complications were considered,” the researchers wrote.

The study authors include Lu Zhang, Ph.D., of Qilu University of Technology, Jinan, Shandong, China; Peng Su, M.D., of Shandong Provincial Hospital Affiliated to Shandong First Medical University; and Jing Li, B.S. of West China Hospital, Sichuan University, Chengdu, China.