Screw-Only Fixation Found to Be Safe and Effective for Intra-Articular Calcaneal Fractures

A retrospective study analyzing intra-articular calcaneal fracture management found that screw-only fixation, whether used for open reduction internal fixation (ORIF) or primary fusion, resulted in faster return to activity compared with plate-based fixation. Researchers found no significant differences in fracture union rates, wound complications, or return to the operating room between screw-only and plate-based constructs, supporting the use of screw-only fixation as a safe and effective approach. This study was presented at the American College of Foot and Ankle Surgeons Scientific Conference in Phoenix, AZ.

Intra-articular calcaneal fractures present a complex challenge due to the need for stable fixation while minimizing soft tissue complications. Various surgical approaches, including sinus tarsi, lateral extensile, and percutaneous incisions, have been described in literature on intra-articular calcaneal fracture management and used in clinical practice. While plate-based fixation is commonly used, concerns over soft tissue irritation and hardware prominence have prompted interest in screw-only fixation. This study aimed to evaluate how different fixation techniques influence union rates, wound healing, and return to function.

Researchers conducted a retrospective review of 31 intra-articular calcaneal fractures in 28 patients treated by a single surgeon, with an average follow-up of 19.3 months. Logistic regression was used to assess factors contributing to delayed or nonunion, wound complications, return to activity, union rates, and reoperation. Fixation methods included ORIF with screws, ORIF with plates, primary fusion with screws, and primary fusion with plates. Incisional approaches varied, including sinus tarsi, lateral extensile, and percutaneous techniques.

Of the fractures studied, 12.9% developed delayed or nonunion, while 19.4% had incision-related wound healing complications, though no deep infections occurred. A total of 35.5% of cases required return to the operating room. Regression analysis revealed that ORIF with screws and primary fusion with screws were associated with a significantly faster return to activity compared with plate-based fixation (P = .01 and P = .05, respectively). However, no significant differences were found among the fixation methods regarding fracture union rates, wound complications, or reoperation rates.

“We conclude that screw-only fixation can be safely utilized for ORIF and primary fusion of intra-articular calcaneal fractures, irrespective of incisional approach,” the authors stated. “Desired fracture and articular exposure and soft tissue envelope quality should guide incisional approach.”

Reference
Page TS, Knauer OA, Chappell TM. Intra-articular calcaneal fractures can be safely and effectively treated with screw-only fixation. Presented at: American College of Foot and Ankle Surgeons Scientific Conference; March 27-30, 2025; Phoenix, AZ. Accessed March 17, 2025. https://imis.acfas.org/ACFAS2025/ACFAS2025/Abstracts.aspx?hkey=5209f2e8-69fc-4935-8823-799c8f5c2922