Outcomes of Calcaneal Fracture Fixation in a One-Day Surgery Setting
DOI:
https://doi.org/10.56929/jseaortho-2025-0264Keywords:
calcaneal fracture, one-day surgeryAbstract
Purpose: This study aimed to evaluate the feasibility and outcomes of minimally invasive calcaneal fracture fixation with screws in a one-day surgery setting. This study investigated whether this technique achieves satisfactory clinical, radiographic, and patient-reported outcomes without increasing the incidence of postoperative complications.
Methods: A retrospective review was conducted of 23 consecutive patients with Sanders type II tongue-type intra-articular calcaneal fractures treated with minimally invasive screw fixation in a one-day surgery setting between January 2010 and February 2024. All procedures were performed by one surgeon under regional anesthesia. Standardized perioperative management included a popliteal sciatic nerve block, multimodal oral analgesia, and structured follow-ups. The outcomes assessed were operative time, postoperative pain (visual analog scale [VAS]]), Böhler angle, perioperative complications, and patient satisfaction.
Results: The patients’ mean age was 44.9 ± 10.6 years, with a mean injury-to-surgery interval of 9.2 ± 4.6 days. Sixteen patients underwent fixation via the sinus tarsi approach and seven via a percutaneous approach. Immediate postoperative pain was minimal (VAS; 0.4 ± 1.2), increasing to a mean of 3.2 ± 2.4 at 24 h; one patient (4.3%) experienced severe pain, managed with oral analgesics. The mean Böhler’s angle increased from 3.6 ± 11.4° preoperatively to 25.2 ± 6.3° postoperatively. No hospital readmissions, wound complications, sural nerve injuries, or losses of reduction were observed. Patient satisfaction was high (mean; 4.8 ± 0.4/5). At four weeks, radiographs showed progressive fracture healing with initiation of weightbearing, and by 12 weeks, all cases demonstrated union without implant failure, infection, or delayed union.
Conclusions: Calcaneal fracture fixation with screws through the sinus tarsi approach can be effectively performed in a one-day surgery setting, resulting in favorable outcomes.
References
Attenasio A, Heiman E, Hong IS, et al. Postoperative wound complications in extensile lateral approach versus sinus tarsi approach for calcaneal fractures: Are we improving? Updated meta-analysis of recent literature. Injury 2024;55:111560.
Li LH, Guo YZ, Wang H, et al. Less wound complications of a sinus tarsi approach compared to an extended lateral approach for the treatment of displaced intraarticular calcaneal fracture: A randomized clinical trial in 64 patients. Medicine (Baltimore) 2016;95:e4628.
Martín-Ferrero MÁ, Faour-Martín O, Simon-Perez C, et al. Ambulatory surgery in orthopedics: experience of over 10,000 patients. J Orthop Sci 2014;19:332-8.
Athar MS, Fazal MA, Ashwood N, et al. Daycase trauma list: a safe and cost-effective service delivery. Ann R Coll Surg Engl 2019;101:519-21.
Thoen CW, Sæle M, Strandberg RB, et al. Patients’ experiences of day surgery and recovery: A meta‐ethnography. Nurs Open 2023;11:e2055.
Mendicino RW, Statler TK, Catanzariti AR. Popliteal sciatic nerve blocks after foot and ankle surgery: an adjunct to postoperative analgesia. J Foot Ankle Surg 2002;41:338-41.
Albright RH, Schneider E, Majeed A, et al. Outpatient surgical fixation of complicated calcaneal fractures pose no excess risk for 30-day complications. J Foot Ankle Surg 2025;64:253-5.
Wang Z, Wang XH, Li SL, et al. Minimally invasive (sinus tarsi) approach for calcaneal fractures. J Orthop Surg 2016;11:164.
Zhang G, Ding S, Ruan Z. Minimally invasive treatment of calcaneal fracture. J Int Med Res 2019;47:3946-54.
Li Y, Zhang Q, Wang Y, et al. Ultrasound-guided single popliteal sciatic nerve block is an effective postoperative analgesia strategy for calcaneal fracture: a randomized clinical trial. BMC Musculoskelet Disord 2021;22:735.
Rayes J, Sharplin P, Maalouf P, et al. A stepwise minimally invasive sinus tarsi approach to open reduction and internal fixation of displaced intra-articular calcaneal fractures: Technique tip. Foot Ankle Int 2023;44:565-73.
Fahey E, Elsheikh MFH, Davey MS, et al. Telemedicine in orthopedic surgery: A systematic review of current evidence. Telemed J E Health 2022;28:613-35.
Cao Y, Xu X, Guo Y, et al. Percutaneous Cannulated Screw Fixation vs. Plating With Minimally Invasive Longitudinal Approach After Closed Reduction for Intra-Articular Tongue-Type Calcaneal Fractures: A Retrospective Cohort Study. Front Surg 2022:9:854210.
Allegra PR, Rivera S, Desai SS, et al. Intra-articular calcaneus fractures: Current concepts review. Foot Ankle Orthop 2020;5:2473011420927334.
Bailey EJ, Waggoner SM, Albert MJ, et al. Intraarticular calcaneus fractures: a biomechanical comparison or two fixation methods. J Orthop Trauma 1997;11:34-7.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 The Royal College of Orthopaedic Surgeons of Thailand
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
