Clinical and radiologic outcomes of minimally invasive locking plate versus screw fixation for displaced intra-articular calcaneal fractures (DIACFs) via sinus tarsi approach: a comparative study.

Introduction: The optimal surgical treatment approach for calcaneal fractures remains controversial. This retrospective comparative study aimed to compare the clinical and radiological outcomes of minimally invasive locking plate fixation with those of screw fixation for displaced intra-articular calcaneus fractures (DIACFs) treated via the sinus tarsi approach (STA).

Methods: A total of 38 patients and 40 feet with DIACFs from 2015 to 2020 were retrospectively reviewed with a minimum of 3 years of follow-up. Patients were divided into two groups based on fixation method: minimally invasive locking plate fixation (MIP group) versus screw fixation (SW group) (17 vs 23, respectively). The clinical outcomes were evaluated by the Visual Analogue Scale (VAS), Maryland Foot Score (MFS), Olerud-Molander (OM) ankle score, American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and occurrence of complications. Radiological outcomes were assessed by radiographs for multiple parameters, including calcaneal height, length, width, and Böhler's angle.

Results: The patients were followed up for an average of 63.37 months. There was no significant difference in the final VAS score, MFS, OM score, AOFAS score, and the total incidence of complications between the two groups (P>0.05). Regarding the radiological outcome, there was also no significant difference in the reduction loss of calcaneal height, length, width, and Böhler's angle (P>0.05) after a one-year follow-up period. However, the rate of implant removal in the MIP group was significantly greater than that in the SW group (P< 0.05).

Conclusions: Minimally invasive locking plate fixation versus screw fixation of DIACFs via sinus tarsi approach may yield comparable radiological and functional outcomes. The screw fixation group suggested a shorter surgical time and lower implant removal rate. Both surgical methods are viable options for DIACFs. However, further large-scale prospective studies are warranted to confirm these results.