PERCUTANEOUS KIRSCHNER WIRES FOR THE TREATMENT OF DISPLACED INTRA-ARTICULAR FRACTURES OF CALCANEUS: A PROSPECTIVE STUDY

Displaced intra-articular calcaneus fractures (DIACFs) are sources of potential disability to the patient, economic burden to the society and a treatment challenge to the average orthopaedic surgeon. Up to date, there is no single approach that is universally applicable to all DIACFs. ORIF can be associated with significant wound complications. Conservative treatment may not be acceptable in a young active patient because of malunion and secondary subtalar osteoarthritis. The minimally invasive surgery (MIS) for DIACFs strives to strike a balance between ORIF and conservative treatment. The aim of this prospective study was to evaluate the functional and radiographic outcomes of closed reduction and percutaneous multiple K-wires fixation as a minimally invasive technique for treatment of Sanders type II & III DIACFs. This prospective study was conducted on 14 patients (9 males and 5 females) with 17 displaced intra-articular calcaneal fractures, managed by closed reduction and multiple K-wires fixation in Sohag university hospitals. The results were assessed at the end of follow up clinically using AOFAS ankle-hind foot scale and radiographically by plain radiographs. The mean age at time of operation was 36.57 ± 12.005 (range, 23-57) years. The right side was affected in 6 (42.9%) patients, while the left in 5 (35.7%) and there were 3(21.4%) patients with bilateral involvement. The patients were consecutive; 9 (64.3%) were males and 5 (35.7%) were females. The most common mechanism of injury was falling from height in 11(78.6%) patients. Four (28.6%) patients were smokers. The mean time lapsed to surgery was 5.07 ± 4.35 (range, 1-14) days. The mean length of follow-up was 10.07 ± 3.95 (range, 6-17) months. The mean AOFAS score at the final follow up was 74.4 ±12.73 (range, 45−90) points. There was a significant reduction of the mean VAS score for pain from 7.31 pre-operatively to 3.54 at the 4th week post-operatively, and to 1.69 at the final follow-up, (P values <0.001). Radiographic evaluation of the hindfoot revealed post-operative improvement of Böhler’s angle, angle of Gissane, posterior facet inclination angle, calcaneal width, length, and height. Closed reduction and minimally invasive internal fixation through percutaneous multiple K-Wire fixation is an effective treatment for carefully selected cases of DIACFs with acceptable functional and radiographic results and fewer complication rates.