J Orthop Surg Res. 2026 Jan 21. doi: 10.1186/s13018-025-06630-1. Online ahead of print.
ABSTRACT
OBJECTIVE: This study aimed to evaluate the functional and radiographic outcomes of full arthroscopic subtalar joint arthroscopy combined with a calcaneal distractor for the management of Sanders type II and III calcaneal fractures.
METHODS: A retrospective analysis was conducted on 26 patients (26 feet) with Sanders type II and III calcaneal fractures who underwent treatment utilizing a full arthroscopic subtalar arthroscopy technique combined with a calcaneal distractor. The surgeries were performed in the Department of Orthopedics at Xuzhou Central Hospital between January 2019 and December 2022. The cohort included 20 males and 6 females, with a mean age of 47.96 ± 8.87 years (range: 34-66 years). According to the Sanders classification, 7 fractures were type II and 19 were type III. Preoperative assessments yielded the following scores: a mean Visual Analogue Scale (VAS) score for pain of 7.35 ± 1.06 points (range: 4-9), a mean American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score of 52.27 ± 9.52 points (range: 55-85), and a mean SF-36 quality of life score of 92.04 ± 4.88 points (range: 80-100).All patients underwent fixation via the combined subtalar joint arthroscopy and calcaneal distractor approach. Postoperative evaluations focused on wound healing status, quality of fracture reduction, and evidence of bony union. Functional outcomes and pain levels were assessed using the VAS, AOFAS ankle-hindfoot score, and the SF-36 questionnaire. A comparison of preoperative and final follow-up scores was performed using the independent samples t-test.
RESULTS: All procedures were successfully completed without intraoperative complications. The mean operative time was 69.7 ± 10.4 min (range: 40-110). All surgical incisions achieved primary healing, with no instances of soft tissue infection, necrosis, or sensory disturbances observed during the postoperative period. Postoperative radiographic measurements of the calcaneus, including its length, width, height, Böhler’s angle, and Gissane’s angle, demonstrated significant improvement compared to preoperative values (all P < 0.01). Furthermore, no statistically significant differences were observed in these parameters between the immediate postoperative period and the final follow-up (all P > 0.05), indicating well-maintained fracture reduction and satisfactory healing. The patients showed significant improvement in the VAS, AOFAS, and SF-36 scores postoperatively compared to their preoperative status (all P < 0.01). At the final follow-up, functional outcomes were satisfactory. According to the AOFAS ankle-hindfoot scale, the scores were graded as excellent in 24 cases and good in 2 cases, yielding an excellent-good rate of 100.0%.
CONCLUSION: The combined technique of full arthroscopic subtalar arthroscopy and a calcaneal distractor demonstrates high precision in fracture reduction and satisfactory clinical outcomes, establishing it as a reliable and effective method for managing Sanders type II and III calcaneal fractures.
PMID:41566367 | DOI:10.1186/s13018-025-06630-1
