C-Nail in displaced intra-articular calcaneal fractures is E
C-Nail tends to be a promising alternative in the treatment of calcaneal fractures & in Sanders IV fractures.

Locking plate osteosynthesis via an L-shaped lateral approach is the gold standard in treating displaced intra-articular calcaneal fractures. The most frequent complications are wound edge necrosis and superficial wound infections. To reduce complication rates, a locking intramedullary nail (C-Nail) was developed that can be implanted minimally invasively via a sinus tarsi approach.

Researchers compared the postoperative complication rate and the outcome of plate osteosynthesis versus C-Nail in displaced intra-articular calcaneal fractures.

All patients with calcaneal fractures who received osteosynthesis with either plate or C-Nail were retrospectively analyzed. A subgroup analysis was performed with matched pairs (matching Sanders type, age, Böhler’s angle postoperative in normal range, 33 pairs). Endpoints were postoperative complication rate, bone healing, full weight-bearing and functional outcome. Treatment groups were compared using Fisher’s exact test for binary data, and Mann-Whitney U-test for continuous data. 101 calcaneal fractures were included (C-Nail n=52, plate n=49).

--Patients with C-Nail developed significantly less postoperative complications, especially wound edge necrosis.

--Screw malposition was found more often in the C-Nail group.

--The rates of achieving full weight-bearing as well as bone healing were comparable in both groups, but in each case significant faster in the C-nail subgroup. The results of the matched-pairs analysis were comparable.

In conclusion, the C-Nail community had a slightly lower postoperative complication rate. Because of the minimal-invasive implantation and high primary durability, the C-Nail tends to be a promising alternative in the treatment of calcaneal fractures, also in Sanders IV fractures.

Source: https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02349-x