Clinical application of robot-assisted fixation for calcaneal fractures: a meta-analysis with subgroup comparisons

Robot-assisted percutaneous cannulated screw fixation is an emerging minimally invasive technique for calcaneal fractures; however, its comparative effectiveness remains uncertain. This systematic review and meta-analysis evaluated perioperative outcomes, radiographic restoration, functional recovery, and complications associated with robot-assisted fixation. PubMed, Embase, Cochrane Library, Web of Science, and CNKI were searched from inception to April 2026. Controlled studies comparing robot-assisted and conventional fixation were included. Two reviewers independently performed study selection, data extraction, and quality assessment. Meta-analyses and subgroup analyses according to robotic platforms (TiRobot, Holosight, and unspecified systems) were conducted using Review Manager 5.4. Fourteen studies involving 812 patients (401 robot-assisted and 411 conventional cases), including two randomized controlled trials and twelve non-randomized studies, were included. Compared with conventional fixation, robot-assisted procedures reduced intraoperative blood loss (MD = - 28.65), incision length (MD = - 5.70), hospital stay (MD = - 3.38), guidewire adjustments (MD = - 2.17), and fluoroscopy exposure (MD = - 4.81). Robot-assisted fixation improved calcaneal morphological restoration and Gissane angle, while Böhler angle improvement was mainly observed in the TiRobot subgroup. It also shortened fracture healing time (MD = - 1.21), reduced pain scores (MD = - 0.92), increased AOFAS scores (MD = 5.33), and decreased overall complications (OR = 0.18). Operative time was slightly prolonged, particularly in the TiRobot subgroup. Robot-assisted fixation may provide short-term benefits in perioperative recovery, anatomical restoration, functional outcomes, and complication reduction for calcaneal fractures. TiRobot has the largest evidence base and demonstrated relatively consistent favorable outcomes; however, its superiority over other robotic platforms remains unconfirmed due to limited comparative evidence. Current evidence is mainly derived from Chinese cohorts with limited follow-up, and long-term functional and economic outcomes remain insufficiently reported. Further international multicenter studies with longer follow-up are warranted.