Combo or perimeter plate? fixation strategy for intra-articular calcaneal fracture via the sinus tarsi approach: a retrospective cohort study

Abstract Background The sinus tarsi approach (STA) is a minimally invasive approach for intra-articular calcaneal fractures. Compared to the extended lateral approach (ELA), STA offers fewer wound complications and allows early operation. After obtaining a sound reduction of posterior facet and hindfoot alignment, the fixation strategy which varies from K-wire to plate can be used. In our study, we focused on Combo and perimeter plates. To evaluate the clinical results between these two plates, we conducted this retrospective clinical study. Methods From January 2022 to July 2025, 38 patients with closed intra-articular calcaneal fractures who received open reduction and internal fixation (ORIF) with Combo or perimeter plate via the sinus tarsi approach were recruited. All patients underwent postoperative clinical and radiological evaluation. Results Patients were followed up postoperatively. The following scores and parameters were recorded (Combo group vs. perimeter group): value of VAS (0.24 ± 0.44 vs. 0.32 ± 0.48), The AOFAS Ankle-Hindfoot score (94.1 ± 4.0 vs. 92.0 ± 5.1), Böhler’s angle (31.67 ± 3.15° vs. 30.05 ± 2.09°), Gissane’s angle (116.71 ± 6.73° vs. 117.16 ± 5.57°), calcaneal length (86.24 ± 4.58 mm vs. 86.34 ± 4.02 mm), and calcaneal height (87.38 ± 4.07 mm vs. 86.86 ± 3.38 mm) showed no statistically significant difference between the two groups after 6–22 months’ follow-up. However, calcaneal width was significantly smaller in the perimeter group at the last follow-up (38.99 ± 3.33 mm vs. 36.01 ± 3.22 mm). There was no wound necrosis, infection, or malunion in these two groups. Conclusion In this retrospective cohort, both Combo and perimeter plate fixation via the sinus tarsi approach appeared feasible, with acceptable radiological and clinical results at short-term follow-up. These findings should be interpreted within the limits of the small sample size and short follow-up, and do not establish clinical equivalence between the two strategies.