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. 2021 Oct;141(10):1691-1699.
doi: 10.1007/s00402-020-03649-3. Epub 2020 Oct 27.

Surgical experience as a decisive factor for the outcome of calcaneal fractures using locking compression plate: results of 3 years

Sebastian Fischer  1 , Magalie Meinert  2 , Oliver Neun  3 , Christian Colcuc  4 , Yves Gramlich  2 , Reinhard Hoffmann  2 , Sebastian Manegold  3
Affiliations

Surgical experience as a decisive factor for the outcome of calcaneal fractures using locking compression plate: results of 3 years

Sebastian Fischer et al. Arch Orthop Trauma Surg. 2021 Oct.

Abstract

Introduction: Calcaneal fractures account for 60-75% of all tarsal fractures and represent surgical challenges because of their frequency and complexity. Despite standardized procedures and new implants, literature reports high revision rates and unsatisfactory results. The study aims to describe the role of the surgeon with respect to the clinical outcome.

Methods: Between 2014 and 2017, 94 calcaneal fractures (all type AO C1-3) were re-examined in 86 patients (67 male and 19 female; mean age: 51 years). The treatment was always carried out by means of locking compression plate via the extensile lateral approach. A comparison was made between treatment by an experienced (ES) and less experienced surgeon (LES). Annually, the ES performed at least 30 procedures for calcaneus fracture treatment as compared to < 10 operations performed by the LES.

Results: The mean AOFAS, VAS FA, and Kiel Score in the ES group were 77.0 (SD 15.9), 69.0 (SD 18.8), and 65.0 (SD 20.6), respectively. The corresponding values in the LES group were 68.1 (SD 21.0), 60.3 (SD 22.4), and 53.0 (SD 21.9) (p < 0.05). The operation time was on average 14 min shorter in the ES group than the LES group (p < 0.05).

Conclusion: The significantly better scores, along with shorter operation time, shorter duration of incapacity to work, and lower complication rate prove the importance of having an experienced surgeon perform complex intra-articular calcaneal fracture repairs. The extensile lateral approach is still considered the standard method.

Level of evidence: Level III, comparative series.

Keywords: Calcaneal fracture; Extensile lateral approach; Learning curve; Locking plate fixation; Open reduction.

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