Nia Arastoo, Hajdu Stefan, Sarahrudi Kambiz, Widhalm Harald Kurt, Popp Domenik, Schmoelz Lukas, Doering Kevin, Tiefenboeck Thomas
Department of Traumatology and Orthopedics, Division of Trauma Surgery, Medical University of Vienna, 1090 Vienna, Austria.
Department Medicine, Danube Private University, 3500 Krems an der Donau, Austria.
J Clin Med. 2025 Mar 16;14(6):2015. doi: 10.3390/jcm14062015.
The management of intra-articular displaced calcaneal fractures remains controversial. Both minimally invasive technique (MIT) and open reduction internal fixation (ORIF) are commonly employed, but there is no clear consensus on the optimal approach. Open surgical techniques carry a higher risk of wound complications, whereas percutaneous methods may offer less precise fracture reduction, while conservative therapy (CT) shows higher functional complications. The aim of this retrospective study was to compare the radiological and functional outcomes of three treatment methods for calcaneal fractures. Patients admitted to two level-one trauma centers between 2013 and 2023 were analyzed. Clinical and radiological parameters and scores were collected. The outcome measures were assessed using Böhler's and Gissane's angles. The clinical results were compared using the Visual Analogue Scale (VAS), the American Orthopaedic Foot and Ankle Society Hindfoot Score (AOFAS), the Maryland Foot Score (MFS), and the Parker Mobility Score (PMS) at the 12-month follow-up. A total of 236 patients with 256 calcaneal fractures were analyzed. Among them, 175 men and 61 women were included. The mean patient age was 46.3 (min-max) years. In total, 130 patients were treated operatively (minimally invasive technique or ORIF), and 106 were treated conservatively. Böhler's and Gissane's angles at follow-up were significantly higher within the operated group. Complications occurred more frequently in the surgical treatment group than in the conservative treatment group, especially deep infections within ORIF ( < 0.001). MFS and VAS yielded better results for surgical treatment. Based on the results of this study, surgical treatment is preferable to conservative treatment due to better anatomical reduction and a slightly better functional outcome. One-year results for all three methods were comparable, showing good clinical and functional results with the surgical groups.
关节内移位跟骨骨折的治疗仍存在争议。微创技术（MIT）和切开复位内固定术（ORIF）都被普遍采用，但对于最佳治疗方法尚无明确共识。开放手术技术伤口并发症风险较高，而经皮方法可能骨折复位不够精确，保守治疗（CT）则显示功能并发症较多。这项回顾性研究的目的是比较三种跟骨骨折治疗方法的影像学和功能结果。分析了2013年至2023年期间入住两家一级创伤中心的患者。收集了临床和影像学参数及评分。使用Böhler角和Gissane角评估结果指标。在12个月随访时，使用视觉模拟量表（VAS）、美国矫形足踝协会后足评分（AOFAS）、马里兰足部评分（MFS）和帕克活动评分（PMS）比较临床结果。共分析了236例患者的256例跟骨骨折。其中包括175名男性和61名女性。患者平均年龄为46.3（最小-最大）岁。总共130例患者接受了手术治疗（微创技术或ORIF），106例接受了保守治疗。随访时，手术组的Böhler角和Gissane角明显更高。手术治疗组的并发症发生率高于保守治疗组，尤其是ORIF组的深部感染（<0.001）。MFS和VAS在手术治疗中取得了更好的结果。基于本研究结果，由于手术治疗能实现更好的解剖复位和稍好的功能结果，因此手术治疗优于保守治疗。所有三种方法的一年结果相当，手术组显示出良好的临床和功能结果。
