Robot-assisted versus conventional percutaneous screw fixation in calcaneal fractures: a retrospective analysis

This study aimed to evaluate the impact of robotic guidance on screw placement accuracy and clinical outcomes in patients with calcaneal fractures. The primary research question was whether robot-assisted fixation provides superior surgical precision and recovery compared to conventional percutaneous techniques.

A retrospective review of 98 patients treated between April 2022 and March 2024 was conducted. Patients were assigned to either a robot-assisted group (RA, n = 54) or a conventional percutaneous fixation group (CPF, n = 44). Parameters compared included operative time, blood loss, fluoroscopy use, intraoperative technical accuracy, hospital stay, fracture healing time, weight-bearing timeline, radiographic measurements, complication rates, VAS pain scores, and AOFAS scores. Follow-ups were performed at 3, 6, and 12 months postoperatively.

Both groups showed significant postoperative improvements in calcaneal morphology. At 3 months, the RA group had significantly better restoration of length, width, height, Böhler's and Gissane's angles and step-off (all p < 0.05). The RA group had shorter operative time, reduced blood loss, fewer fluoroscopy exposures, fewer guidewire adjustments, faster fracture healing, and shorter hospital stay (all p < 0.001, except hospital stay p = 0.034). Surgical precision was enhanced with a higher first-attempt guide pin success rate (94.4% vs. 72.7%, p = 0.004) and no intra-articular misplacements (vs. 11.4%, p = 0.028). VAS pain scores and complication rates were significantly lower in the RA group. AOFAS scores were higher at 3 months (p = 0.045).

Robot-assisted percutaneous fixation improves screw placement accuracy, reduces early postoperative pain and complications, and promotes faster early recovery in calcaneal fractures.