Minimally Invasive Treatment of Calcaneal Fractures Based on 3D Fluoroscopic Robot-Assisted Percutaneous Reduction and Screw Fixation Combined With a Novel Circular Distractor.

OBJECTIVES

To introduce a surgical technique and evaluate the clinical outcome of minimally invasive treatment of calcaneal fractures based on 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation combined with a novel circular distractor.

DESIGN

Retrospective case series.

SETTING

Single Level-1 trauma center.

PATIENTS: Adult patients with calcaneal fractures (OTA/AO 82C, Sanders type II, III) who were treated with 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation combined with a novel circular distractor from January 2022 to June 2024 were included.

OUTCOME MEASURES AND COMPARISONS: Demographic characteristics, operative information, radiological and functional outcomes, and complications.

RESULTS

Forty-seven patients (43 men and 4 women, 52 fractures) with a mean age of 46.5 ± 12.2 years (range: 24-73), a mean weight of 73.4 ± 13.0 kg (range: 55-106), and a mean height of 170.1 ± 6.4 cm (range: 150-180) were followed for an average duration of 20.4 months (range: 9-36 months). According to the Sanders classification, there were 39 type II and 13 type III fractures. Based on the Essex-Lopresti classification, 25 fractures were tongue-type and 27 were joint depression-type. The average time from injury to surgery was 8.7 ± 4.2 days (range: 2-18), and the mean operative duration was 86.8 ± 33.9 minutes (range: 45-180). Postoperative radiographic parameter assessment revealed significant restoration of the calcaneal anatomy, with a marked reduction in width (from 47.8 ± 4.6 to 43.4 ± 4.2 mm, P < 0.001) and significant improvements in height (from 39.3 ± 4.8 to 46.2 ± 4.0 mm, P < 0.001) and length (from 79.2 ± 5.9 to 81.6 ± 5.1 mm, P < 0.001). Furthermore, both Böhler angle (from 7.4 ± 13.5 to 25.4 ± 9.2 degrees, P < 0.001) and Gissane angle (from 119.3 ± 13.4 to 113.4 ± 10.1 degree, P < 0.001) were significantly corrected. The vertical articular step significantly decreased from 4.3 ± 0.8 mm before the operation to 0.9 ± 0.5 mm ( P < 0.001). There were no wound complications. At the final follow-up, the mean Maryland Foot Scale, American Orthopedic Foot and Ankle Society ankle-hindfoot score, and visual analogue scale score were 93.5 ± 6.4, 91.3 ± 7.6, and 1.0 ± 1.0, respectively. No patients required secondary surgery, except for 5 patients for whom the internal fixation was removed.

CONCLUSIONS

This study demonstrated favorable clinical outcomes for the minimally invasive treatment of calcaneal fractures using 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation in combination with a novel circular distractor. This surgical protocol is suggested to be both safe and reliable on the basis of this findings.

LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.