Early Surgery and Screw-Only Osteosyntheses in Minimally Invasive Treatment of Calcaneal Fractures-Risk or Benefit...

Background: This study aims to analyze the outcomes following the minimally invasive surgery of calcaneal fractures using screw-only osteosynthesis, as well as the impact of surgical timing. Methods: Between 2015 and 2020, 155 patients with 168 fractures were included. According to the Sanders classification, 48.21% of fractures were classified as Sanders 2, 33.33% as Sanders 3, and 10.11% as Sanders 4 fractures, with the remaining fractures unclassified. A total of 117 cases were treated on the day of admission or the following day. The surgeries followed a standardized protocol for fracture analysis, positioning, and X-ray techniques, primarily using a percutaneous approach with stab incisions. Osteosynthesis was mainly performed using screws, with five cases treated with K-wires for open fractures. Results: The mean Boehler's angle improved from 8.52° preoperatively to 25.00° postoperatively. Three superficial infections were observed. Deep infections occurred in three cases, all following open fractures. Secondary dislocation was noted in five patients-one due to a deep infection, and four attributed to clear technical failures. One case involved a questionable indication for a screw change (7.3 mm screw) after two weeks due to perforation of the medial wall. A total of 79 fractures were followed up for an average of 4 years and 3 months. The mean AOFAS score was 91.3, and the mean FAOS score was 88.7. Surgery within 7 days after admission showed no significant impact on the outcomes. Conclusions: Minimally invasive screw-only osteosynthesis with early surgical intervention offers favorable outcomes with minimal risk.