Radiological and Functional Outcomes of Screw-Only versus Screw-and-Mini-Plate Fixation for Intra-Articular Calcaneal Fractures.

Abstract

Displaced intra-articular calcaneal fractures (DIACFs) are challenging injuries. The sinus tarsi approach (STA) offers comparable reduction quality to the extensile lateral approach with lower complication rates. The optimal fixation method following STA remains debated. This study aimed to compare radiological and functional outcomes of a modified screw fixation(MSF) versus screw plus mini-plate fixation (PF) in DIACFs. Retrospective Comparative Study, Level 3 Evidence. This retrospective study included 40 patients(42 fractures) treated via STA between September 2018 and May 2024.Patients aged ≥16 years with Sanders type II-III fractures, ≥12 months of follow-up, treated via sinus tarsi approach and complete radiographs/CT scans were included; open injuries, subtalar dislocation, prior foot/ankle surgery were excluded.Group A(MSF, n=22) underwent screw-only fixation and Group B(PF, n=20) received a lateral mini-plate plus percutaneous screws. Radiological assessment included Böhler and Gissane angles, calcaneal height, length, width, and posterior facet step-off. Functional outcomes were evaluated using the Visual Analog Scale (VAS), AOFAS Hindfoot Score, EFAS Score, and Olerud-Molander Score(OM). Both groups showed significant postoperative improvement in radiological parameters(p<0.01), with no intergroup differences. Group A demonstrated superior clinical results with lower VAS(2.00±1.66 vs. 3.45±1.76, p=0.011), higher EFAS(17.82±5.06 vs. 14.40±5.75, p=0.038), and higher OM scores(79.09±16.81 vs. 59.50±20.06, p=0.001). AOFAS scores favored Group A without statistical significance(p=0.066). Implant removal was less frequent in Group A(13.6% vs. 30.0%) without statistical significance(p=0.269). The MSF technique, performed via STA yields superior functional outcomes, lower pain scores, and reduced complication rates compared to PF in the surgical treatment of DIACF.