A comparison of absorbable screws and metallic plates in treating calcaneal fractures: a prospective randomized trial

Intra-articular calcaneal fractures are more likely to suffer consequences in terms of pain and disability. Many studies have suggested that operative treatment for these fractures may result in better outcomes than nonoperative treatment. The metallic screws and plates are among the most common alternatives to stabilize calcaneal fractures. However, the complications of plating of calcaneal fractures are not uncommon. Complications such as infection, poor wound healing, and soft tissue irritation exist. With the advent of bioabsorbable screws, many reports have demonstrated favorable results in treating intra-articular fractures with these screws. The comparative outcomes of operative treatment of calcaneal fractures stabilized with plates and absorbable screws are rarely reported. The purpose of this study is to compare the clinical outcomes and complications related to fracture stabilization with plates and absorbable screws.

Ninety-seven patients with intra-articular calcaneal fractures were managed at our institution between February 2007 and March 2009. In this prospective, randomized study, the plates were used in 52 cases (group A), and the absorbable screws were used in 47 cases (group B). There were 71 men and 26 women who had a mean age of 41 years (range, 19–67 years). The clinical outcome and complications were assessed and compared. The adjusted American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (subjective component only), Foot Function Index, and the calcaneal fracture scoring system were used to assess the results.

The patients were followed up at an average of 23 months (range, 15–32 months). Radiographically, there were no nonunions in either group. One year after operation, in group A and B, the mean adjusted American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score were 71.6 ± 12.5 and 72.3 ± 17.4, respectively (p > 0.05); the mean Foot Function Index score were 21.4 ± 6.6 and 22.7 ±5.2, respectively (p > 0.05); and the mean calcaneal fracture scoring system score were 73.5 ± 8.3 and 75.1 ± 6.9, respectively (p >0.05). In group A, there were six cases of poor wound healing, one case of deep infection, and four cases of peroneal tendon irritation.In group B, there was one case of superficial infection, and no deep infection and soft tissue irritation.

In this report, the outcomes of operative treatment with absorbable screws are comparable with the outcomes of operative treatment with plates. Both plates and absorbable screws showed favorable results in the surgical treatment of calcaneal fractures. However,the metallic plates were associated with increased complications. The stabilizations of displaced intra-articular calcaneal fractures with bioabsorbable screws are reasonable with advantages of fewer complications and without the need for screw removal.