Published date : 25 July 2012
Article date : 21 June 2012
Research reported in the February issue of the Journal of Trauma and Acute Care Surgery, has suggested that treatment of intra-articular calcaneal fractures with bioabsorbale screws may present advantages in clinical outcomes compared to stabilization with plates and absorbale screws.
In a prospective, randomized study, 97 patients undergoing treatment for intra-articular calcaneal fractures between February 2007 and March 2009 were assigned to two groups: 52 cases receiving treatment with plates (group A) and 47 cases with absorbale screws (group B). Clinical outcomes and incicidence of complications were subsequently assessed and compared using the adjusted American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (subjective component only), Foot Function Index, and the calcaneal fracture scoring system, at an average follow-up time of 23 months.
Results showed no incidence of nonunion in either group. One year post-operative outcomes were reported as follows:
mean adjusted American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score: group A: 71.6 ± 12.5, group B: 72.3 ± 17.4 (p > 0.05)
mean Foot Function Index score: group A: 21.4 ± 6.6, group B: 22.7 ±5.2 (p > 0.05)
mean calcaneal fracture scoring system score: group A: 73.5 ± 8.3, group B: 75.1 ± 6.9, (p >0.05)
In terms of complications, the patient group treated with plates reported six cases of poor wound healing, one case of deep infection, and four cases of peroneal tendon irritation. Of those patients receiving fracture stabilization treatment with absorbable screws, only one case of superficial infection, and no deep infection and soft tissue irritation was reported.
Although these results show that outcomes of operative treatment with absorbable screws and outcomes of operative treatment with plates are comparable, with both groups presenting favourable results as surgical tratment options for calcaneal fractures, the study does suggest that metalic plate treatment is associated with a higher risk of complications. Fracture stabilization with bioabsorbale screws presents the advantages of lower complication rates and avoids the need for screw removal.