Percutaneous reduction had fewer complications than sinus tarsi fixation for simpler calcaneal fractures

Design

Systematic review and meta-analysis of 8 comparative studies (level III)

Population

837 patients with displaced intra-articular calcaneal fractures, mostly Sanders II-III

Primary outcome

Complication rate; functional and radiological outcomes

Effect

Overall complications RR 0.47 (95% CI 0.27-0.83); AOFAS difference 0.82 points

Both closed percutaneous reduction and the mini-open sinus tarsi approach aim to avoid the wound problems of the extensile lateral approach for displaced intra-articular calcaneal fractures. This meta-analysis pooled eight comparative studies, 837 patients, mostly with Sanders type II and III fractures.

Percutaneous reduction was associated with fewer overall complications, including wound complications (RR 0.47, 95% CI 0.27-0.83). AOFAS scores differed by less than one point, which the authors judge of doubtful clinical relevance. Radiological alignment was similar, though calcaneal width stayed wider after percutaneous reduction. Operative time, time to surgery and length of stay were shorter, with high heterogeneity.

The evidence is level III, largely non-randomised, and limited to less complex fracture patterns. Surgeons may have chosen percutaneous reduction for the more favourable fractures.

For Sanders II and III fractures, percutaneous reduction is a reasonable option where the surgeon is experienced with it. It does not settle the approach for more comminuted fractures.

• For Sanders II-III fractures, percutaneous reduction was linked to about half the complication rate of sinus tarsi fixation.
• Function scores were effectively the same with either approach.
• Check calcaneal width on post-reduction imaging; it remained wider after percutaneous reduction.
• This evidence does not cover Sanders IV or highly comminuted fractures.
• Choose the approach you can perform reliably; most studies were non-randomised.

Why it matters

Wound complications drive much of the harm in calcaneal fixation, and this points to the less invasive of the two minimally invasive options.

Don't overread it

Most studies were non-randomised, so fracture selection may explain part of the difference.

The statistics, in plain English

A risk ratio of 0.47 means complications occurred at about half the rate. The interval stays below 1. A 0.82-point AOFAS difference is statistically detectable but far below what a patient would notice.

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