Percutaneous Reduction and Fixation with Kirschner Wires versus Open Reduction Internal Fixation for the Management of Calcaneal Fractures: A Meta-Analysis

Knowledge and expertise in managing closed fractures of the calcaneus in adults has significantly increased over the past few years. Conservative management methods have been popular1, consisting of reducing the width of the calcaneus with use of a hammer, taking care to limit soft tissue trauma, followed by plantarflexion of the forefoot to restore the plantar arch. As this technique does not directly reduce the subtalar joint and requires immobilization in a plaster cast, post-traumatic osteoarthritis and joint stiffness are common complications of a conservative management2. With advancements in surgical techniques, open reduction and internal fixation with plates (ORIF), via an L-shaped lateral approach, has become the standard method for treating displaced, intra-articular calcaneal fractures3. ORIF provides a direct reduction of the articular facet of the calcaneus, which forms the subtalar joint, and allows early mobilization. However, this open reduction technique is associated with a high risk of soft tissue complications related to the surgical wound, such as: hematoma formation, skin edge necrosis, wound breakdown, and superficial or deep infection4. Recently, minimally invasive reduction and fixation has emerged as an alternative to ORIF to avoid soft tissue complications5. In recent years, the popularity of using percutaneous reduction and fixation with Kirschner wires (PRFK) as a minimally invasive treatment for calcaneal fractures has increased in China. This procedure usually consists of inserting a Kirschner wires (K-wire), using a joystick, from the calcaneal tuberosity to beneath the subtalar joint, with plantarflexion of the forefoot used to reduce the fracture. After the K-wire is advanced into the distal fracture fragment, augmentation fixation using one or two K-wires is necessary. However, there are no clear guidelines to inform the selection of either a PRFK or ORIF approach for the management of calcaneal fractures in adults. Therefore, we conducted a literature search to identify randomized controlled trials (RCTs) comparing PRFK and ORIF techniques and performed a meta-analysis with the intent of evaluating the evidence to inform selection of the preferred technique.