Therapeutic effect of interlocking intramedullary nailing for Sanders types Ⅱ and Ⅲ calcane-al fractures

Ma Feifei; Zheng Kaifu; Chen Jinwu; Liu Qiang; Ma Lijuan

doi:10.3969/j.issn.1009-4237.2025.02.007

Abstract：Objective To investigate the clinical effect of interlocking intramedullary nailing for Sanders types Ⅱ and Ⅲ calcaneal fractures.Methods This retrospective analysis was performed on 54 patients with closed calcaneal fractures(Sanders types Ⅱ and Ⅲ)who received surgical treatment and followed up in the Department of Traumatic Orthopedics,CR&WISCO General Hospital affiliated to Wuhan University of Science and Technology from Sep.2020 to Sep.2023.The causes of injury were 43 falls from height,7 impact/crush injuries,and 4 road traffic in-juries.According to the treatment they received,patients were divided into screw group(25 cases)and plate group(29 cases).In the screw group,there were 17 males and 8 females of 29-67(mean 50.3)years.They were treated with percutaneous reduction and interlocking intramedullary nailing,with 9 affecting the left side and 16 the right.In the plate group,there were 18 males and 11 females of 31-69(mean 49.3)years,who were treated by open reduction and plate internal fixation,with 12 cases affecting the left side and 17 the right.The surgery parameters(incision length,intraoperative blood loss,operation time,length of hospital stay,preoperative preparation time),VAS,imaging indicators(calcaneal Bohler angle,Gissane angle and calcaneal width),American Association of Foot and Ankle Surgery(AOFAS)ankle-hindfoot score and postoperative complications were compared between the two groups.Results Compared with the plate group,the screw group showed significantly shorter incision(cm,2.4±1.2 vs.10.1±0.8),less intraoperative blood loss(mL,21.6±3.5 vs.75.5±21.5),and shorter operation time(min,77.6±11.3 vs.95.2±11.5),length of hospital stay(d,7.6±1.9 vs.14.1±2.8)and preoperative preparation time(d,2.6±1.3 vs.5.5±1.1),all P<0.05.The VAS at 48 h after surgery was also much lower in the screw group(3.9±0.8 vs.4.3±0.7,P<0.05).At six months after operation,the Bohler angle and Gissane angle of the calca-neus increased,the calcaneus width decreased,and the AOFAS ankle-hindfoot score improved for both groups(all P<0.05 compared with before surgery),while comparison between the two groups showed no significant difference(all P>0.05).The incidence of postoperative complications in the screw group was 4.0%,lower than that in the plate group(24.1%,P>0.05).Conclusion Percutaneous reduction and interlocking intramedullary nailing in the treatment of Sanders types Ⅱ and Ⅲ calcaneal fractures show comparable therapeutic effects with traditional plate internal fixation,which however has the advantages of shorter incision length,less intraoperative bleeding,shorter op-eration and hospital stay,shorter preoperative preparation time,and less pain.These advantages accelerate postoper-ative rehabilitation and are thus worthy of clinical promotion.