Percutaneous screw configuration versus perimeter plating of calcaneus fractures: A cadaver study

Background: Percutaneous screw configuration has been used clinically to reduce the high rate of wound complications associated with the extensile approach of standard open reduction and internal plate fixation. The aim of this cadaveric biomechanical study was to compare the strength of the standard perimeter plating with that of the percutaneous screw configuration for a Sanders type-2B calcaneus fracture. Materials and Methods: Ten pairs of fresh-frozen cadaveric lower limbs were prepared and osteotomized to create a Sanders type-2B fracture. Of each pair, one specimen underwent open reduction and internal fixation with standard perimeter plating; the other was stabilized with the percutaneous screw configuration. Each foot was compressed axially via the talar dome (1 mm/sec) until failure occurred. Differences in treatment groups were analyzed for significance (p < 0.05) using paired t-tests. Results: Construct stiffness was 158 ± 85 and 113 ± 60 N/mm for the plate and percutaneous fixation, respectively (p = 0.18). Failure occurred at an average of 1156 ± 513 and 1064 ± 540 N for the plate and percutaneous construct, respectively (p = 0.65). Conclusion: The results suggest that open reduction and internal fixation with percutaneous screw configuration for Sanders type-2B calcaneus fractures provides a strength similar to that of perimeter plating. Clinical Relevance: Percutaneous screw fixation of calcaneus fractures may provide fracture reduction similar to plate fixation.