A comparison of clinical and radiologic outcomes of intra-articular calcaneal fracture treatment with the Ilizarov method and internal fixation - a two-center study.

Abstract

Expert opinions are divided regarding the optimal methods for different types of calcaneal fracture fixations. Comparison of different methods of calcaneal fracture fixations. This two-center retrospective study compared clinical and radiological outcomes and fracture-healing time for calcaneal fractures treated with the Ilizarov method (n=26) versus plate fixation (n=19); the median patient age was 55.00 (36.00-60.00) and 46.24 (38.14-53.00) years, respectively (p = 0.241). The median duration of hospitalization was 8.00 (8.00-10.00) days in the plate group and 9.00 (9.00-12.00) days in the Ilizarov group (p < 0.001). The median fracture healing time was 65.00 (56.00-66.00) days in the plate group and 82.50 (78.00-92.00) days in the Ilizarov group (p < 0.001). The median AOFAS score at final follow-up was 74.00 (66.00-85.00) in the Ilizarov group and 67.00 (59.00-79.50) in the plate group (p < 0.001). Complications (superficial infections) were noted in 5 patients (19.23%) in the Ilizarov group and in none of the patients in the plate group (p = 0.042). After treatment 2 patients (7.69%) of those treated with Ilizarov method and 12 patients (63.16%) of plate stabilization group received analgesics beyond the standard protocol (additional administration of Morphine 5 mg SC q6h PRN), (p < 0.001). Osteoarthritis of the subtalar joints was more common in the plate group (17 patients, 89.47%) compared with the Ilizarov group (8 patients, 30.77%), (p < 0.001). Changes were assessed based on the last follow-up X-rays. Osteoarthritis in the Ilizarov vs plate group were 0.00% vs 10.53% (p = 0.09) in the ankle joint, 30.77% vs 47.37% (p = 0.256) in the talocalcaneal joint, 0.00% vs 68.42% (p < 0.001) in the calcaneocuboid joint, and 0.00% vs 73.68% (p < 0.001) in the talonavicular joint. Significant changes in Böhler and Gissane angles were observed in both groups. The Ilizarov group, compared to plate group, allows for the achievement of some better radiological parameters (Böhler and Gissane angles, less development of osteoarthritic changes) and some better clinical results (AOFAS scale, satisfaction with treatment, decreased using analgesics after treatment). The plate group had fewer complications and a shorter hospital length of stay and fracture healing time. Given the two-center design, imbalance in Sanders severity, and lack of blinding for subjective outcomes, these findings should be interpreted cautiously. III, Case-control study.