Comparison and predictive factors analysis for efficacy and safety of Kirschner wire, anatomical plate fixation and cannulated screw in treating patients with open calcaneal fractures

Abstract

This study aimed to compare the efficacy and safety among Kirschner wire, anatomical plate fixation and cannulated screw treatments in patients with open calcaneal fractures, and to explore the predictive factors for treatment response and complication occurrence.The 142 open calcaneal fracture patients were enrolled in this study, who received fixation procedures of Kirschner wire, anatomical plate fixation or cannulated screw on demand. Treatment efficacy was assessed by AOFAS score and occurrence of complications was recorded.No difference of AOFAS score was observed among Kirschner wire, anatomical plate fixation and cannulated screw groups (P = .792), and the numbers of patients with excellent, good, medium, and poor AOFAS score in Kirschner wire group were 16 (16.2%), 42 (42.4%), 32 (32.3%), and 9 (9.1%), which in anatomical plate fixation group were 4 (16.7%), 11 (45.8%), 7 (29.2%), and (8.3%), and in cannulated screw group were 1 (5.3%), 10 (52.6%), 6 (31.6%), and 2 (10.5%), respectively. No difference of total complication occurrence (P = .709) or specific complications including skin graft (P = .419), flap graft (P = .229), deep infection (P = .644) or amputation (P = .428) was discovered among 3 groups. Logistic regression analysis revealed that fixation options did not affect treatment response and complication occurrence (all P > .05), while higher Gustilo type correlates with decreased treatment response (P < .001) and elevated complication occurrence (P < .001) independently.Kirschner wire, anatomical plate fixation, and cannulated screw are equally efficient and tolerated in treating patients with open calcaneal fractures, and higher Gustilo type correlates with decreased treatment response and increased complication occurrence independently.

Figure 1

Treatment efficacy assessed by AOFAS score. Percentage of patients with excellent score was 16.2% (n = 16), 16.7% (n = 4), and 5.3% (n = 1) in Kirschner wire group, anatomical plate fixation group and cannulated screw group, respectively; the percentage of patients with good score was 42.4% (n = 42), 45.8% (n = 11), and 52.6% (n = 10) in 3 groups, respectively; the percentage of patients with medium score was 32.3% (n = 32), 29.2% (n = 7), and 31.6% (n = 6) in 3 groups, respectively; the percentage of patients with poor score was 9.1% (n = 9), 8.3% (n = 2), and 10.5% (n = 2) in 3 groups, respectively. No difference of AOFAS score was found among the 3 groups. Kruskal-Wallis H rank sum test was used to compared the difference among groups. P < .05 was considered significant. AOFAS = American Orthopaedic Foot and Ankle Society.