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Background <p>The optimal surgical approach for displaced intra-articular calcaneal fractures remains contentious. While minimally invasive surgery (MIS) reduces soft-tissue complications, its application in complex fractures is debated. Ligamentotaxis, a cornerstone of MIS, requires an intact calcaneal tuberosity as a fulcrum. This study evaluates the utility of preoperative tuberosity integrity assessment in guiding surgical approach selection.</p> Methods <p>In this retrospective case–control study, 118 patients (2019–2022) were allocated to two treatment algorithms due to an institutional protocol evolution. Group A (Sanders-guided, n = 51) received MIS for Sanders type II/III and ELA for type IV. Group B (tuberosity-guided, n = 67) received MIS if the tuberosity was intact or an extended lateral approach (ELA) if comminuted. Outcomes included operative metrics, radiographic reduction (Böhler’s angle, facet step-off), functional scores (AOFAS, Maryland Foot Score), VAS pain scores, and complications.</p> Results <p>No significant differences were observed in radiographic or functional outcomes between the two groups. However, the tuberosity-guided approach suggested a potential reduction in operative time for fractures with comminuted tuberosity (93.5 ± 6.1&#xa0;min vs. 103.2 ± 4.7&#xa0;min, p = 0.017, a preliminary finding due to the small sample size). Analysis of the entire cohort (n = 118) revealed that the wound complication rate was notably higher when comminuted tuberosity fractures were treated with STA (2/2, 100%) compared to ELA (1/9, 11.1%, p = 0.011). Furthermore, among all STA cases, patients with comminuted tuberosity had a markedly higher observed complication rate than those with intact tuberosity (100% vs. 9.5%, <i>p</i> &lt; 0.001).</p> Conclusion <p>Preoperative assessment of calcaneal tuberosity integrity offers a potentially valuable adjunct to the Sanders classification for selecting the surgical approach in displaced intra-articular calcaneal fractures. It achieves comparable clinical outcomes. Given the exploratory nature of subgroup analyses based on a limited number of comminuted fractures, the findings regarding enhanced operative efficiency and complication profiles are preliminary and require validation in larger, prospective cohorts.</p>

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The guiding significance of calcaneal tuberosity integrity in the surgical treatment of calcaneal fractures: a retrospective case–control study

  • 期刊论文

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  • 发表日期：

    2026年6月23日

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  • Gang Luo,
  • Xing Du,
  • Zenghui Wang,
  • Weidong Ni

摘要

Background

The optimal surgical approach for displaced intra-articular calcaneal fractures remains contentious. While minimally invasive surgery (MIS) reduces soft-tissue complications, its application in complex fractures is debated. Ligamentotaxis, a cornerstone of MIS, requires an intact calcaneal tuberosity as a fulcrum. This study evaluates the utility of preoperative tuberosity integrity assessment in guiding surgical approach selection.

Methods

In this retrospective case–control study, 118 patients (2019–2022) were allocated to two treatment algorithms due to an institutional protocol evolution. Group A (Sanders-guided, n = 51) received MIS for Sanders type II/III and ELA for type IV. Group B (tuberosity-guided, n = 67) received MIS if the tuberosity was intact or an extended lateral approach (ELA) if comminuted. Outcomes included operative metrics, radiographic reduction (Böhler’s angle, facet step-off), functional scores (AOFAS, Maryland Foot Score), VAS pain scores, and complications.

Results

No significant differences were observed in radiographic or functional outcomes between the two groups. However, the tuberosity-guided approach suggested a potential reduction in operative time for fractures with comminuted tuberosity (93.5 ± 6.1 min vs. 103.2 ± 4.7 min, p = 0.017, a preliminary finding due to the small sample size). Analysis of the entire cohort (n = 118) revealed that the wound complication rate was notably higher when comminuted tuberosity fractures were treated with STA (2/2, 100%) compared to ELA (1/9, 11.1%, p = 0.011). Furthermore, among all STA cases, patients with comminuted tuberosity had a markedly higher observed complication rate than those with intact tuberosity (100% vs. 9.5%, p < 0.001).

Conclusion

Preoperative assessment of calcaneal tuberosity integrity offers a potentially valuable adjunct to the Sanders classification for selecting the surgical approach in displaced intra-articular calcaneal fractures. It achieves comparable clinical outcomes. Given the exploratory nature of subgroup analyses based on a limited number of comminuted fractures, the findings regarding enhanced operative efficiency and complication profiles are preliminary and require validation in larger, prospective cohorts.