Comparison of closed pry-pick reduction titanium needle fixation and open reduction plate fixation in the treatment of Essex-Lopresti type Ⅱ articular surface collapse calcaneal fractures: a prospective study
Authors: Li Changhui , Liu Wenze , Yin Hongyuan , Wang Tianyu , Ding Jiakai , Li Pengfei , Song Lianxin , Zhang Xuebin 
Published: November 2024

Background
To compare the clinical efficacy of closed pry-pick reduction titanium needle fixation and "L" type incision open reduction plate fixation in the treatment of Essex-Lopresti type Ⅱ articular surface collapse calcaneal fractures.
Methods
A total of 260 patients with Essex-Lopresti type Ⅱ articular surface collapse calcaneal fractures who received surgical treatment in our hospital from January 2018 to January 2023 were taken as the observation objects. According to the results of random drawing, all patients were divided into the control group and the study group, each with 130 cases. The control group underwent "L" type incision open reduction plate fixation, while the study group underwent closed pry-pick reduction titanium needle fixation. The Böhler Angle, Gissane Angle, postoperative adverse events, hospital stays, operation time, intraoperative blood loss, and American Orthopedic Foot and Ankle Society Scores(AOFAS) at 1 day before operation, 3 months after operation, 6 months after operation and 1 year after operation were compared between the two groups.
Results
There was no significant difference in Böhler Angle and Gissane Angle between the study group and the control group 1 day before surgery and 3 days after surgery (P > 0.05). The incidence of postoperative adverse events in the study group was 1.54%, which was lower than 10.77% in the control group (P < 0.05). The hospitalization time, operation time and intraoperative blood loss in the study group were lower than those in the control group (P < 0.05). There was no significant difference in AOFAS score between the two groups 1 day before surgery (P > 0.05). At 3 months after operation, AOFAS score of control group was higher than that of study group (P < 0.05). There was no significant difference in AOFAS score between the two groups at 6 months after operation (P > 0.05). One year after surgery, the AOFAS score of the study group was higher than that of the control group (P < 0.05). In patients with BMI ≥ 24, AOFAS scores at 3 months and 6 months after surgery in the control group were higher than those in the study group with statistical significance (P < 0.05); there was no significant difference in AOFAS scores between the two groups 1 year after operation (P > 0.05). Among the patients with BMI < 24, the AOFAS score 3 months after operation in the control group was higher than that in the study group (P < 0.05); there was no statistical significance in AOFAS score 6 months after operation between the two groups (P > 0.05); the AOFAS score of the study group was higher than that of the control group at 1 year after operation (P < 0.05).
Conclusions
Compared with the traditional "L" type incision open reduction plate fixation, the treatment of Essex-Lopresti type Ⅱ articular surface collapse calcaneal fracture with closed pry-pick reduction titanium needle fixation has satisfactory clinical efficacy, less trauma and less postoperative adverse events. Although the use of traditional "L" type incision open reduction plate fixation in the treatment of calcaneal fracture may achieve better short-term functional recovery, from the perspective of long-term prevention of postoperative adverse events and postoperative functional recovery benefits, the author recommends the use of closed pry-pick reduction titanium needle fixation in the treatment of Essex-Lopresti type Ⅱ articular surface collapse calcaneal fractures.