Background: Open reduction with internal fixation (ORIF) and percutaneous surgery (PS) are the most common\nsurgical procedures for the treatment of displaced intra-articular calcaneal fractures. The purpose of this\nretrospective study was to compare the clinical and radiological results of these techniques and to verify the\nprognostic value of the radiographic measurement tools proposed in the literature.\nMethods: A consecutive series of 104 calcaneal fractures was included in this analysis. Essex-Lopresti and Sanders\nclassifications were used to evaluate the injuries, and their prognostic correlation was tested. B�¶hlerâ��s angle was\nmeasured pre- and postoperatively and evaluated as radiological outcome. Clinical outcomes were evaluated using\nthe American Orthopaedic Foot and Ankle Society hindfoot scale (AOFAS), Maryland Foot Scale (MFS), 17-Foot\nFunction Index (FFI), Short Form-36 (PCS), and a 10-point visual analogue scale (VAS).\nResults: A total of 87 fractures (5 bilateral), 54 in males and 28 in females, were evaluated with a mean follow-up of\n77.0 months. Overall mean age was 51.6 years old. The most frequent cause of trauma was a fall from a height.\nAccording to Essex-Lopresti, there were 58 joint depression fractures, 26 tongue, and 3 comminute. According to\nSanders: 37 type II, 31 type III, and 19 type IV. Patients were divided into three groups according to surgical\ntreatment: 19 in the ORIF group, 35 in the PS Screw group, and 33 in PS K-wire group. The ORIF group obtained\nsignificantly better results (82 AOFAS, 86 MFS, 19.6 FFI, 46.2 PCS, 8 VAS) with respect to the PS K-wire group (74\nAOFAS, 76 MSF, 26.4 FFI, 40.8 PCS, 6 VAS). The PS Screw group obtained intermediate results (79 AOFAS, 82 MFS,\n22.4 FFI, 41.6 PCS, 7 VAS). The restoration of the B�¶hlerâ��s angle was achieved most frequently (p = 0.02) in the ORIF\ngroup, without better clinical results.\nConclusion: The results were best in the ORIF group, despite its risk of complications, inferior in the PS Screw\ngroup, however without statistical significance (p > 0.05), and worse in the PS K-wire group. Finally, our data\nconfirmed the prognostic correlation between the two radiographic classifications used and the clinical outcomes.
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