Systematic review reveals lower skin complication rates with percutaneous versus open fixation in calcaneal avulsion fractures, suggesting less invasive techniques benefit select patients.
INTRODUCTION: Beak-type avulsion fractures of the posterior calcaneal tuberosity have a high risk of skin complications due to Achilles tendon traction and limited soft tissue coverage. The objective was to synthesize evidence on their surgical management, comparing open and percutaneous approaches, focusing on skin complications and prognostic factors. MATERIAL AND METHODS: Systematic review following PRISMA 2020. Search in PubMed/MEDLINE and ScienceDirect (2000-2024). Clinical studies describing open reduction with internal fixation (ORIF) or closed reduction with percutaneous fixation (CRIF) were included. Narrative synthesis was performed due to methodological heterogeneity. RESULTS: Fourteen observational studies (268 patients) were included. Comparative series consistently showed a trend toward lower skin complication rates with CRIF compared to ORIF. Time to surgery (<48h) and fragment displacement (>2cm) were identified as relevant prognostic factors. CONCLUSION: In selected fractures with moderate displacement, percutaneous fixation represents a reasonable option to minimize skin complications. Open fixation remains necessary for significantly displaced or comminuted injuries.
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Puchol et al. (2026) studied this question.
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