Minimally invasive internal fixation of Sanders IV calcaneal fractures using a tarsal sinus plate and cannulated screws

This study aimed to assess the clinical efficacy of combining tarsal sinus plates with cannulated screw-based minimally invasive internal fixation for the management of Sanders type IV calcaneal fractures. Between January 2019 and July 2023, we conducted a retrospective analysis of 32 cases involving Sanders type IV calcaneal fractures treated by our medical team. The treatment approach involved the utilization of tarsal sinus plates in conjunction with minimally invasive internal fixation using cannulated screws. Among the cases analyzed, there were 16 males and 16 females, with an average age of 34.5 years (ranging from 21 to 50 years). We observed and recorded key parameters, including operative duration, intraoperative blood loss, postoperative complications, preoperative and immediate postoperative calcaneal width, calcaneal Bohler angle, and Gissane angle. Additionally, we conducted a review and documented the healing progress six months postoperatively. Pain levels were assessed using the visual analogue scale (VAS) before the procedure and at the final follow-up, while foot function was evaluated using the AOFAS (American Orthopaedic Foot and Ankle Society) Ankle Hindfoot Scale. The mean operative time for the 32 patients was 100.5 min (ranging from 62 to 144 min), with an average blood loss of 80 ml (ranging from 61 to 110 ml). Importantly, all fractures achieved union, with a 100% success rate, and no adverse complications were recorded. Postoperative X-ray imaging revealed statistically significant improvements in calcaneal width, Bohler angle, and Gissane angle compared to preoperative measurements (P < 0.05). All patients were subject to follow-up assessments, with the average follow-up duration being 18 months (ranging from 12 to 24 months). At the final follow-up, patients reported a notably lower VAS pain score of 1.3 ± 0.2 points, a statistically significant reduction (P < 0.05) when compared to preoperative values. Furthermore, the average AOFAS score at this stage was 84.4 ± 6.3 points, also demonstrating a statistically significant improvement compared to preoperative scores (P < 0.05). Combining tarsal sinus plates with cannulated screw-based minimally invasive internal fixation is an effective treatment modality for Sanders type IV calcaneal fractures. This approach offers several advantages, including minimal trauma, a low risk of postoperative infection, reduced likelihood of soft tissue necrosis in the skin flap, superior fracture reduction and fixation, expedited functional recovery, and a reduced incidence of postoperative complications.