Percutaneous Cannulated Screw Fixation vs. Open Reduction and Plate Fixation for Displaced Intraarticular Calcaneal Fracture: A Two-Center Retrospective Propensity-Matched Analysis.

Purpose The optimal surgical strategy for the treatment of displaced intra-articular calcaneal fractures remains controversial.The purpose of this retrospective cohort study was to compare the clinical and radiologic outcomes of open reduction and plate fixation (ORPF) via the sinus tarsi approach versus percutaneous cannulated screw fixation (PCSF) in patients with displaced intra-articular calcaneal fractures with follow-up to 2 years. Methods A retrospective analysis was performed on the records of all patients with displaced intra-articular calcaneal fractures (Sanders types II and III) who were admitted to two level I trauma centers between January 2018 and December 2022. Data were analyzed using propensity score matching (PSM) at a 1:1 ratio. The primary outcome was assessed using the AOFAS score for evaluating ankle function. Secondary outcomes included operative time, postoperative VAS, wound complication rates, and hardware removal rates. Radiological outcome assessment was conducted based on X-rays taken preoperatively and 3 months post-injury. Results A total of 143 patients were included in the analysis. We successfully matched 62 patients in the ORPF cohort with 62 patients in the PCSF cohort using PSM. At 24 months, there was no significant difference in the AOFAS scores between the two groups ( P  > .05); similarly, there were no significant differences in radiological outcomes at 3 months postoperatively (P > .05). However, the PCSF group had significantly lower operative time (65 ± 35 min vs 95 ± 40 min, P < .01), postoperative VAS score (5 ± 1 vs 8 ± 1.5, P < .05), wound complication rates (3.2% vs 9.6%, P < .01), and hardware removal rates (14.5% vs 0, P < .01) compared to the ORPF group. Conclusion In this study, we found that both surgical procedures resulted in satisfactory ankle function and radiological outcomes. The PCSF group was associated with lower VAS scores, fewer wound complications, a lower reoperation rate, and no cases requiring hardware removal.