# A tailored distractor-assisted percutaneous minimally invasive treatment for Sanders II and III calcaneus fractures: a consecutive cohort study with medium-term results

## TL;DR

A new minimally invasive surgery using a tailored distractor improves outcomes for certain calcaneus fractures, showing effective recovery and reduced complications.

## Contribution

Introduces a tailored distractor-assisted minimally invasive surgery for Sanders II and III calcaneus fractures with medium-term results.

## Key findings

- Tailored distractor-assisted MIS achieved effective fracture reduction and improved radiographic measurements in calcaneus fractures.
- Patients showed significant functional improvement with average AOFAS score of 81.4 and low complication rate of 6.3%.
- Surgical duration and hospital stay were short, averaging 40.1 minutes and 4.9 days respectively.

## Abstract

The treatment strategy of displaced intra-articular calcaneal fractures (DIACFs) remains challenging. While the operation techniques vary widely, the efforts is now on the optimization of surgical techniques to better DIACFs management. This study aimed to introduce a tailored distractor-assisted percutaneous minimally invasive surgery (MIS) and reported its medium-term outcomes in patients with Sanders II and III calcaneus fractures.

63 cases (63 feet) of DIACFs, subjected to a tailored distractor-assisted MIS in our orthopedic department were retrospectively analyzed. The medical records and radiological measurements were retrieved for efficiency evaluation. At the last follow-up, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hind foot score and Visual Analog Scale (VAS) score were used to evaluate the functional rehabilitation. Postoperative complications were also recorded.

All feet (39 Sanders type II fractures and 24 Sanders type III) successfully achieved fracture reduction with the interval between injury to operation average 1.3 days, the duration of surgery average 40.1 min, and the hospital stay average 4.9 days. Radiographic measurements revealed significant differences between pre-operation and post-operation in calcaneal height and width, so as to Bohler's angle and Gissane angle (p < 0.05, respectively). Anatomical or near-anatomical realignment of the posterior subtalar articular surfaces were achieved in all cases. At the last follow-up, the AOFAS and the VAS score was average 81.4 and 1.3 points, both significantly improved from that of pre-operation (p < 0.05, respectively). Four feet (6.3%) encountered postoperative complications.

Application of the tailored calcaneal distractor in MIS for Sanders type II and III calcaneal fractures has demonstrated advantages in effectively manipulating fracture reduction and yielding favorable clinical outcomes. Further cohort study is required to clarify its clinical significance vs. other techniques.