JOT - 2026-06-01 - Journal Article
Minimally Invasive Treatment of Calcaneal Fractures Based on 3D Fluoroscopic Robot-Assisted Percutaneous Reduction and Screw Fixation Combined With a Novel Circular Distractor.
Zhao B, Liu Q, Shen A, Li J, Yang F, Gong M, Wu X, Jiang X, Han W, Wang J
Topics
Key Takeaway
Robot-assisted percutaneous fixation with a novel circular distractor for Sanders II/III calcaneal fractures restored Böhler angle from 7.4° to 25.4° and achieved a mean articular step-off of 0.9 mm with zero wound complications in 52 fractures.
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Summary
This retrospective case series evaluated 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation combined with a novel circular distractor for Sanders II/III calcaneal fractures at a single Level-1 center. Forty-seven patients (52 fractures) underwent the technique with mean operative time of 86.8 minutes; postoperative imaging confirmed significant restoration of calcaneal width, height, Böhler angle, and Gissane angle (all P<0.001). At mean 20.4-month follow-up, mean Maryland Foot Scale was 93.5, AOFAS hindfoot score was 91.3, and no wound complications or secondary surgeries for failure occurred.
Key Limitation
The absence of a comparator group (conventional ORIF or standard percutaneous fixation) makes it impossible to attribute the favorable outcomes—particularly the zero wound complication rate—to the robotic or distractor components rather than patient selection or surgeon experience.
Original Abstract
OBJECTIVES
To introduce a surgical technique and evaluate the clinical outcome of minimally invasive treatment of calcaneal fractures based on 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation combined with a novel circular distractor.
DESIGN
Retrospective case series.
SETTING
Single Level-1 trauma center.
PATIENTS
Adult patients with calcaneal fractures (OTA/AO 82C, Sanders type II, III) who were treated with 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation combined with a novel circular distractor from January 2022 to June 2024 were included.
OUTCOME MEASURES AND COMPARISONS
Demographic characteristics, operative information, radiological and functional outcomes, and complications.
RESULTS
Forty-seven patients (43 men and 4 women, 52 fractures) with a mean age of 46.5 ± 12.2 years (range: 24-73), a mean weight of 73.4 ± 13.0 kg (range: 55-106), and a mean height of 170.1 ± 6.4 cm (range: 150-180) were followed for an average duration of 20.4 months (range: 9-36 months). According to the Sanders classification, there were 39 type II and 13 type III fractures. Based on the Essex-Lopresti classification, 25 fractures were tongue-type and 27 were joint depression-type. The average time from injury to surgery was 8.7 ± 4.2 days (range: 2-18), and the mean operative duration was 86.8 ± 33.9 minutes (range: 45-180). Postoperative radiographic parameter assessment revealed significant restoration of the calcaneal anatomy, with a marked reduction in width (from 47.8 ± 4.6 to 43.4 ± 4.2 mm, P < 0.001) and significant improvements in height (from 39.3 ± 4.8 to 46.2 ± 4.0 mm, P < 0.001) and length (from 79.2 ± 5.9 to 81.6 ± 5.1 mm, P < 0.001). Furthermore, both Böhler angle (from 7.4 ± 13.5 to 25.4 ± 9.2 degrees, P < 0.001) and Gissane angle (from 119.3 ± 13.4 to 113.4 ± 10.1 degree, P < 0.001) were significantly corrected. The vertical articular step significantly decreased from 4.3 ± 0.8 mm before the operation to 0.9 ± 0.5 mm ( P < 0.001). There were no wound complications. At the final follow-up, the mean Maryland Foot Scale, American Orthopedic Foot and Ankle Society ankle-hindfoot score, and visual analogue scale score were 93.5 ± 6.4, 91.3 ± 7.6, and 1.0 ± 1.0, respectively. No patients required secondary surgery, except for 5 patients for whom the internal fixation was removed.
CONCLUSIONS
This study demonstrated favorable clinical outcomes for the minimally invasive treatment of calcaneal fractures using 3D fluoroscopic robot-assisted percutaneous reduction and screw fixation in combination with a novel circular distractor. This surgical protocol is suggested to be both safe and reliable on the basis of this findings.
LEVEL OF EVIDENCE
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.