Management of Sanders type II-III displaced intra-articular calcaneus fractures combined with compromised soft-tissue condition using closed reduction and sequential frame screw technique.

BACKGROUND: Management the Sanders type II-III displaced intra-articular calcaneus fractures (DIACF) combined with compromised soft-tissue condition is full of challenges. The aim of this study was to validating the clinical efficacy and merits of the closed reduction and sequential frame screw technique for managing Sanders type II-III DIACF in conjunction with compromised soft-tissue conditions. METHODS: We conducted a retrospective analysis on 13 patients with Sanders type II-III DIACF accompanied by compromised soft-tissue conditions between March 2022 and October 2023, while assessing postoperative complications as well as functional and radiographic outcomes. RESULTS: The fractures healed uneventfully in a single stage (8-12 weeks postoperatively), with no occurrences of infection, impaired wound healing, or necrosis of the skin and soft tissues during the postoperative period and at the last follow-up. The AOFAS score at the final follow-up was 88.38 ± 7.75, with 7 cases rated as excellent, 5 cases rated as good, and 1 case rated as fair, resulting in an overall excellent or good rate of 92.30%. Additionally, the mean VAS score at the final follow-up was recorded at 1.46 points (ranging from 0 to 3 points). The imaging measurements revealed a statistically significant improvement in the postoperative Gissane angle, Bohler angle, and calcaneal height when compared to preoperative values (P<0.05). Furthermore, no significant differences were found between the postoperative measurements and those recorded at the final follow-up (P>0.05). No cases of obvious varus deformity were observed, and although calcaneal width showed improvement at both postoperative and final follow-up assessments compared to preoperative measurements, these changes were not statistically significant (P>0.05). CONCLUSIONS: The closed reduction technique utilizing Kirschner wire lever and sequential frame screw technique has demonstrated efficacy in the management of Sanders type II-III DIACF accompanied by compromised soft-tissue conditions.