Study on the method of using absorbable screws combined with cannulated screws to treat calcaneal fractures using talar calcaneal distraction technique

Study on the method of using absorbable screws combined with cannulated screws to treat calcaneal fractures using talar calcaneal distraction technique | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Study on the method of using absorbable screws combined with cannulated screws to treat calcaneal fractures using talar calcaneal distraction technique Yubo Wu, Yongqing Zhai, Changhai Wei, Lei Ding, Baofu Wei This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7056109/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : For intra-articular fractures with displaced posterior articular surface of calcaneus, more and more studies have shown that surgical treatment has better functional outcomes than non-surgical treatment. However, it is difficult to correct calcaneal inversion and restore calcaneal length and width during surgery, and traditional fracture fixation methods have many problems. The aim of this study was to explore the method of treating calcaneal fractures by using talar calcaneal distraction technique and absorbable screws combined with cannulated screws through a tarsal sinus incision. Methods: Thirty-five patients with Sanders Ⅱ and Ⅲ calcaneal fractures were divided into two groups according to the treatment methods. The patients were treated with calcaneal talar distraction technique through tarsal sinus incision with plate fixation (17 cases) and calcaneal talar distraction through tarsal sinus incision with absorbable screws combined with cannulated screws (19 cases).The height, width, Böhler angle, and Gissane angle of the calcaneus were measured preoperative, postoperative and at the last follow-up. The AOFAS score of the ankle joint was recorded at the last follow-up. Results All 35 patients were followed up for 10-17 (13.19 ± 1.47) months in group A and 9-18 (13.45 ± 2.80) months in group B. At the last follow-up, the calcaneal height, width, Böhler angle and Gissane angleof the two groups were significantly improved compared with those before surgery, and the differences were statistically significant (P ＜ 0.05); there was no statistically significant difference between the two groups (P ＞0.05). There was no statistically significant difference in AOFAS scores between the two groups (P ＞0.05). Conclusion The calcaneal-talar distraction technique using absorbable screws combined with hollow screws through the tarsal sinus incision to treat calcaneal fractures has the advantages of less trauma, simple reduction, and fewer complications. Its efficacy is equivalent to that of the traditional tarsal sinus incision using steel plates for fixation. calcaneal fracture calcaneal-talar distraction absorbable screw cannulated screw Figures Figure 1 Figure 2 Introduction Calcaneal fractures account for 1% - 4% of total body fractures in adults, with the most common fracture occurring in falling from a height [1 -2 ] . A fracture of the alcaneus usually causes by a high energy injury , 60%-80% of a fracture of the alcaneus causes an intra-articular fracture , and the displacement of the joint surface seriously affects the function of the hindfoot[3-6] . The calcaneus is the largest tarsal bone in the human foot and has four articular surfaces and The posterior articular surface is the main weight-bearing surface. Fractures through the posterior articular surface are often difficult to anatomically reduce, and there are many controversies in the surgical treatment method［7］.The standard surgical approach for calcaneal fractures is open reduction and internal fixation through an extended L-shaped lateral incision. Although this approach provides good fracture exposure and allows fracture reduction under direct vision, it is associated with a high rate of postoperative soft tissue complications ［8-9］.Limited open reduction and internal fixation is one of the most widely used minimally invasive techniques for the treatment of calcaneal fractures in clinical practice.In particular, limited open reduction and internal fixation via the tarsal sinus incision has the advantage that the minimally invasive incision via the lateral tarsal sinus can effectively expose the subtalar articular surface and perform reduction operations on the articular surface under direct vision.However, this approach cannot fully expose the posterolateral surface of the calcaneus, which increases the difficulty of restoring the height and width of the calcaneus during surgery. It is also more likely to damage the sural nerve, especially when removing the fixation device removing[10].We used the talar calcaneal distraction technique to treat Sanders type II and III intra-articular calcaneal fractures using absorbable screws combined with hollow screws, which effectively solved the technical shortcomings of the traditional tarsal sinus incision and achieved significant clinical efficacy.This paper reported a comparison of the clinical efficacy of 35 cases of Sanders II and III calcaneal fractures treated in our department from January 2022 to June 2024, which were treated by first distracting the calcaneus and talus and then fixing with a steel plate through a tarsal sinus incision and first distracting the calcaneus and talus and then using absorbable screws combined with hollow screws through a tarsal sinus incision. Materials and Methods 1. Inclusion and Exclusion Criteria 1. Inclusion criteria: (1) Patients who met the diagnostic criteria for calcaneal fractures[ 11 ]; (2) Patients with intra-articular calcaneal fractures, articular surface collapse > 2 mm and/or articular surface separation > 3 mm as shown by CT scans; (3) Patients with a significant increase in calcaneal width or a significant decrease in height; (4) Sanders II or III calcaneal fractures; (5) Patients with clear consciousness and ability to express themselves clearly; (6) Patients aged ≥ 18 years. 2. Exclusion criteria: (1) patients aged < 18 years; (2) patients with open fractures; (3) patients with soft tissue abrasions of the heel; (4) patients with soft tissue infections around the heel; (5) patients with pathological fractures; (6) patients with vascular diseases of the lower limbs; (7) patients with clear contraindications to surgery and unable to tolerate surgery; (8) patients with fractures in other parts of the lower limbs. 2. Materials and methods 2.1 General information Among the 35 cases included, 33 were males, including one with bilateral fractures, and 2 were females; the average age was (46.72 ± 8.56) years old. The fractures were unilateral or bilateral, with 17 cases on the right side and 19 cases on the left side.The time of injury ranged from 5 to 120 hours, with an average of (27.34 ± 10.88) hours. The preoperative time was from 2 to 17days (7.43 ± 3.85), and the cause of injury was: 31 cases of falling from height and 5 cases of traffic injury. Sanders fracture classification: 11 cases of type II and 25 cases of type III. The preoperative Böhler angle was 2.1°ཞ40.1°, with an average of (9.82 ± 8.47)°; the Gissane angle was 95.3°ཞ138.0°, with an average of (111.68 ± 14.44)°.; Calcaneus height 34.1 ~ 47.7 mm, average (48.12 ± 4.14) mm; Calcaneus width 36.8 ~ 53.3 mm, average (42.27 ± 2.70) mm.All patients were randomly divided into two groups: calcaneal talar distraction tarsal sinus incision plate fixation and calcaneal talar distraction tarsal sinus incision absorbable screw combined with cannulated screw. There were 17 cases in the tarsal sinus incision plate fixation group and 19 cases in the tarsal sinus incision absorbable screw combined with cannulated screw group. There was no significant difference in age, gender, side, Sanders classification, injury time, preoperative Böhler angle, Gissane angle, calcaneal height and width between the two groups (P > 0.05). 2.2 Surgical method Epidural anesthesia. The patient lies on the healthy side (both feet can be prone). ① Group A: From 2 cm below the tip of the lateral malleolus to the base of the fourth metatarsal, a 4–6 cm incision is made to expose the lateral wall of the calcaneus and the subtalar articular surface.A 2.5mm diameter Kirschner wire was placed behind the talar neck and calcaneal tuberosity. A distractor was used to place the wires on the inside and outside of the calcaneus. The inside distractor was used to distract the calcaneus to correct calcaneal varus. The outside distractor was used to distract the calcaneus slightly to correct the shortening and height of the calcaneus. The articular surface fracture was then repositioned.If there is a protrusion on the lateral wall of the calcaneus, use a compressor to correct the protrusion and width of the calcaneus. After loosening the lateral wall of the calcaneus, fix the repositioned calcaneus with a tarsal sinus plate (anatomical locking plate (Jiangsu Xinrong Bolt Medical Equipment Co., Ltd.)), flush it, and suture the incision in layers. ② Epidural anesthesia. The patient was placed in the normal side lying position (both feet were placed in the prone position). ① Group B: From 2 cm below the tip of the lateral malleolus to the base of the fourth metatarsal, a 4–6 cm incision was made to expose the lateral wall of the calcaneus and the subtalar articular surface.A 2.5mm diameter Kirschner wire is placed at the posterior and inferior part of the talar neck and calcaneal tuberosity, respectively. A distractor is used to place the wires on the medial and lateral sides of the calcaneus. The medial distractor is used to distract the calcaneus to correct calcaneal varus. At the same time, the lateral distractor is used to distract the calcaneus slightly. Together with the medial distractor, the shortening and height of the calcaneus are corrected. The joint surface is then repositioned. If there is a protrusion on the lateral wall of the calcaneus, a compressor is used to correct the protrusion and width of the calcaneus.A 6.0 mm diameter hollow screw (metal hollow bone screw (Jiangsu Baiyide Medical Technology Co., Ltd.)) was implanted from the inner and outer sides of the posterior calcaneus to the inner and outer sides respectively to maintain the height and length of the calcaneus. A 3.5 mm diameter absorbable screw (Chengdu Dikang Zhongke Biomedical Materials Co., Ltd.) was used to fix the reduced joint surface. After flushing, the incision was sutured in layers. 2.3 Postoperative treatment Elevate the affected foot. Start foot and ankle active and passive functional exercises 2 days after surgery. Remove sutures after 2 weeks, gradually start weight-bearing activities after 8 weeks, and fully weight-bearing after 12 weeks. Take lateral and axial heel X-rays after surgery to evaluate the effect of surgical reduction. 2.4 Statistical analysis SPSS 20.0 software was used for statistical analysis. Measurement data were expressed as X − ±s. Inter-group comparisons were performed using independent sample t-tests, and t′-tests were used when variances were unequal; intra-group comparisons were performed using paired t-tests; and enumeration data were compared using χ2 tests. Results All patients were followed up for 3 to 12 (6.25 ± 3.39) months in group A and 4 to 17 (6.58 ± 4.09) months in group B. One case in group A had delayed healing of the skin incision edge, which was cured after wound dressing.One case in group B had delayed healing of the skin incision edge, which was cured after wound dressing.There was no statistically significant difference in complications between the two groups (P >0.05).Imaging examinations showed that the fractures in both groups were basically healed 3 months after surgery.At the last follow-up, the calcaneal width, calcaneal height, Bohler angle and Gissane angle of the two groups were significantly different from those before surgery (P 0.05), see Table 2 ;There were no statistically significant differences in calcaneal width, calcaneal height, Böhler angle, Gissane angle, and AOFAS score between the two groups at the last follow-up (P >0.05), see Table 3 .Two groups of typical cases are shown in Figs. 1 and Figs. 2 . Table 1 Comparison of calcaneal width, height and Böhler angle between the two groups before surgery and at the last follow-up time Calcaneus width (mm) Calcaneus height (mm) Gissane Corner (°) Böhler Corner (°) Group A(n = 16) Group B(n = 19) Group A(n = 16) Group B(n = 19) Group A (n = 16) Group B (n = 19) Group A (n = 16) Group B(n = 19) Properative 36.8ཞ53.3 39.0ཞ56.9 31.4ཞ47.7 32.6ཞ45.7 95.3ཞ130.2 83.5ཞ134.9 16.5ཞ36.2 2.1ཞ29.8 46.6 ± 5.0 45.9 ± 5.7 40.9 ± 4.9 39.8 ± 3.7 118.7 ± 10.2 114.1 ± 12.4 26.9 ± 7.0 20.88 ± 8.91 Last follow-up 31.8ཞ44.3 35.9ཞ45.5 37.6ཞ47.9 36.3ཞ51.5 98.3ཞ126.0 107.8ཞ142.8 26.2ཞ43.6 19.8ཞ39.9 40.1 ± 3.9 41.8 ± 3.4 44.3 ± 3.5 42.7 ± 4.4 110.1 ± 11.2 122.8 ± 7.8 21.85 ± 8.84 31.45 ± 5.41 t-value 3.97 2.71 −2.18 −2.20 2.25 2.54 −2.45 -4.37 p-value 0.00045 0.01 0.038 0.03 0.03 0.016 0.02 0.0001 Table 2 Preoperative calcaneal width, calcaneal height, Böhler angle and Gissane angle of the two groups Group Calcaneus width (mm) Calcaneus height (mm) Gissane Corner (°) Böhler Corner (°) A group(n = 16) 36.8ཞ53.3 31.4ཞ47.7 95.3ཞ130.2 16.5ཞ36.2 46.6 ± 5.0 40.9 ± 4.9 118.7 ± 10.2 26.9 ± 7.0 B group(n = 19) 39.0ཞ56.9 32.6ཞ45.7 83.5ཞ134.9 2.1ཞ29.8 45.9 ± 5.7 39.8 ± 3.7 114.1 ± 12.4 21.9 ± 8.8 t-value 0.150 1.51 −1.47 0.54 p-value 0.150 0.14 0.15 0.59 Table 3 The calcaneal width, calcaneal height, Böhler angle, Gissane angle and AOFAS score of the two groups at the last follow-up Calcaneus width (mm) Calcaneus height (mm) Gissane Corner (°) Böhler Corner (°) AOFAS score A group(n = 16) 31.8ཞ44.3 37.6ཞ47.9 98.3ཞ126.0 26.2ཞ43.6 76ཞ94 40.1 ± 3.9 44.3 ± 3.5 110.1 ± 11.2 21.85 ± 8.84 86.31 ± 5.00 B group(n = 19) 39.0ཞ56.9 36.3ཞ51.5 107.8ཞ142.8 19.8ཞ39.9 79ཞ93 45.9 ± 5.7 42.7 ± 4.4 122.8 ± 7.8 31.45 ± 5.41 85.26 ± 5.01 t-value −1.32 0.499 −1.78 −0.48 0.639 p-value 0.195 0.621 0.084 0.63 0.526 Discussion The optimal treatment for calcaneal fractures remains controversial, especially intra-articular fractures with displacement of the posterior articular surface of the calcaneus. An increasing number of studies have shown that surgical treatment tends to improve functional outcomes compared with nonoperative treatment［11］.The key points of surgical treatment of comminuted calcaneal fractures are to restore the flatness of the talocervical joint surface, the Bühler angle and the calcaneal height［12］.Sanders type II and III intra-articular calcaneal fractures have a high disability rate. For calcaneal fractures with a displacement of more than 2 mm of the posterior subtalar articular surface, surgical treatment can achieve better imaging results and clinical efficacy than non-surgical treatment [13]. However, due to complications, there is still no consensus on the standard treatment approach [14-15].Although the L-shaped incision on the lateral side of the calcaneus provides a good visual field, it is prone to complications such as infection, skin edge necrosis, wound nonhealing, and osteomyelitis due to extensive stripping of the periosteum and skin flap during the operation [16].Around the tarsal sinus incision, the terminal branches of the peroneal artery anastomose with surrounding blood vessels to form a rich vascular network. The effect of the tarsal sinus incision on the surrounding blood supply is significantly less than that of the lateral expanded L-shaped incision. The incidence of soft tissue complications decreases as the incision becomes smaller [17].The tarsal sinus incision can directly expose the subtalar articular surface and the calcaneus cuboid joint, which can accurately reduce the articular surface and achieve a strong internal fixation effect when combined with hollow screw fixation.［18］The tarsal sinus approach has advantages over the lateral extended “L” approach in terms of preoperative waiting time, operation time, incision length, postoperative drainage volume, and VAS score[19-23].According to LiS, iatrogenic sural nerve injury occurred in 5 of 52 patients (9.6%) following the sinus tarsi approach [24].When screws or sinus tarsi plates are used via the sinus tarsi approach, removal of the internal fixation after fracture healing poses a risk to the sural nerve. This is because the sural nerve often lies within the scar tissue of the incision, making it difficult to expose; once exposed, dissection of the nerve increases the likelihood of iatrogenic injury.When we use absorbable screws to fix articular surface fractures during surgery, we only need to expose the upper part of the lateral wall of the calcaneus. There is no need to widely dissect the lateral wall of the calcaneus as when using a tarsal sinus plate.Two screws with a diameter of 6.0 mm: the outer screw is fixed from the posterior inferior to the front to maintain the length of the calcaneus and prevent calcaneal inversion; the inner screw is fixed from the posterior inner to the medial superior to maintain the height of the calcaneus. In this way, the 6.0 mm screws and the absorbable screws together form a framework structure to maintain the calcaneal fracture, thereby achieving the fixation effect.After the fracture heals, there is no need to make an incision in the tarsal sinus area because the absorbable screws are absorbed, thus avoiding the risk of sural nerve injury, wound healing risk and infection risk when the fixation device is removed.When removing the two posterior hollow screws with a diameter of 6.0 mm, they are located at the rear and are easy to expose. They can be implanted inside the hollow screws under Kirschner wire detection, avoiding incision complications. Restoring the calcaneal inversion, length, height, width and flatness of the articular surface, that is, restoring the anatomical morphology of the calcaneus to the greatest extent, is the core of surgical treatment of calcaneal fractures.How to restore the length, height, width and flatness of the articular surface of the calcaneus is the key to a successful operation.Calcaneal fractures often present with inversion. The misalignment of the hindfoot force line causes inversion and varus deformity of the hindfoot, which directly leads to early failure of calcaneal fracture treatment and requires long-term calcaneal osteotomy or subtalar joint fusion to relieve clinical symptoms [25-26].Loss of calcaneal height will lead to a widening of the calcaneal width, which may result in impingement of the lateral calcaneus with the peroneal tendons after calcaneal fracture surgery, even if good reduction of the subtalar articular surface is achieved [27].In the past, the tarsal sinus approach was used to correct force alignment, especially calcaneal varus. During the operation, a Steinmann wire was inserted through the calcaneal tuberosity for manual traction, prying, and compression. Since the medial structure of the calcaneus cannot be directly exposed, this operation requires the surgeon to have sufficient understanding of the anatomical structure of the calcaneus, sufficient preoperative planning, and considerable experience in calcaneal reduction surgery, so it places high demands on the surgeon.During the operation, we used Kirschner wires to implant the calcaneal tuberosity and talus, and then used a distractor to distract the calcaneus. The advantage is that it gradually and continuously distracts the medial column, which is not only conducive to correcting calcaneal varus, but also effectively restores the length, height and width of the calcaneus in combination with mild lateral distraction.After restoring the length, height, and width of the calcaneus, the distractor can continue to stabilize the reduction until we fix the fracture with screws. Although this method is easy to operate, it requires the implantation of Kirschner wires on the talus, which poses a risk of affecting the blood supply to the talus. In addition, although the Kirschner wires effectively avoid important structures such as the ankle canal when implanted at the calcaneal tuberosity, they cause damage to skin and soft tissues such as the calcaneal fat pad, increasing the risk of postoperative wound infection. In summary, the talar calcaneal distraction using absorbable screws combined with cannulated screws for the treatment of Sanders II and III calcaneal fractures through the tarsal sinus incision is effective.It has the advantages of less trauma, full exposure of the subtalar joint surface, effective correction of calcaneal force line, and low incidence of postoperative incision complications, and is a recommended treatment method. However, this technology is not suitable for Sanders IV type calcaneal fractures, and the surgical technique learning curve is long, so junior physicians need to be cautious in choosing. Declarations Acknowledgements Not applicable. Author Contributions YW designed the study and wrote the paper. YZ, CW and LD collected the clinical data.All authors read and approved the final manuscript. Funding Not applicable. Ethics approval and consent to participate This study was performed in line with the principles of the Declaration of Helsinki. The information of all participants was collected after obtaining written informed consent. This study was approved by the Ethics Committee of the Linyi First People's Hospital. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References Epstein N, Chandran S, Chou L. Current concepts review: intra-articular fractures of the calcaneus. 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Effect of Subtalar Fusion and Calcaneal Osteotomy on Function, Pain, and Gait Mechanics for Calcaneal Malunion. Foot Ankle Int. 2019;40(9):1094–103. https://doi.org/10.1177/1071100719853291 . Chen W, Li X, Su Y, Zhang Q, Smith WR, Zhang X, Zhang Y. Peroneal tenography to evaluate lateral hindfoot pain after calcaneal fracture. Foot Ankle Int. 2011;32(8):789–95. https://doi.org/10.3113/FAI.2011.0789 . . Additional Declarations No competing interests reported. Supplementary Files SupplementaryMaterials.rar Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7056109","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":495787760,"identity":"838a37c0-ab4b-44aa-a783-ae36cc4685f7","order_by":0,"name":"Yubo Wu","email":"","orcid":"","institution":"Linyi People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yubo","middleName":"","lastName":"Wu","suffix":""},{"id":495787761,"identity":"2dcd05bb-eb34-4851-aa37-fd439dfb669d","order_by":1,"name":"Yongqing Zhai","email":"","orcid":"","institution":"Linyi People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yongqing","middleName":"","lastName":"Zhai","suffix":""},{"id":495787762,"identity":"edbcbb45-689e-4139-9b7b-fe326c7a7a46","order_by":2,"name":"Changhai Wei","email":"","orcid":"","institution":"Linyi People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Changhai","middleName":"","lastName":"Wei","suffix":""},{"id":495787763,"identity":"0def29b2-2379-43b5-9286-dfe43d5ef3df","order_by":3,"name":"Lei Ding","email":"","orcid":"","institution":"Linyi People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lei","middleName":"","lastName":"Ding","suffix":""},{"id":495787764,"identity":"a58389a6-d172-4521-a7ea-f055df462380","order_by":4,"name":"Baofu Wei","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0klEQVRIiWNgGAWjYBACfvb2A4YfKmx4+NmbDxCnRbLnTEKxxJk0OcmeYwnEaTG44WDwgbflkLHBjRwDIl12gyFxg2TDgcSZDTkfb7xhsJPTbSCgg3F242GDwh13EvsZzm62nMOQbGx2gIAWZpkDaQaSZ54lzmzs3SbNw3AgcRshLWwSCeY/eNsOJ244zPOMOC08EgkGBkAtxgbHeNiI0yLBcybBGBLIbMaWcwyI8Iv9cVhUyj9+eONNhZ0cQS1oVhIbNUhaSNUxCkbBKBgFIwIAACf7SWNkMx+cAAAAAElFTkSuQmCC","orcid":"","institution":"Linyi People's Hospital","correspondingAuthor":true,"prefix":"","firstName":"Baofu","middleName":"","lastName":"Wei","suffix":""}],"badges":[],"createdAt":"2025-07-06 06:23:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7056109/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7056109/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":88648762,"identity":"36b53b49-2767-4343-8717-172538045a2b","added_by":"auto","created_at":"2025-08-08 16:55:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":565869,"visible":true,"origin":"","legend":"\u003cp\u003eMale, 38 years old, left calcaneal fracture.After the talus and calcaneus was distracted, the tarsal sinus incision is made and then the tarsal sinus plate was fixed\u003c/p\u003e\n\u003cp\u003ea:talus-calcaneal distraction,b:tarsal sinus incision, c:lateral x-ray of the calcaneus,d:a xial X-ray of calcaneus,e: lateral X-ray of the calcaneus one year later,f: axial X-ray of the calcaneus one year later\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7056109/v1/6465ddf899e1b1034a7e41cc.png"},{"id":88648793,"identity":"636d178d-f2b1-47c5-849b-8630819a216d","added_by":"auto","created_at":"2025-08-08 16:55:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":813550,"visible":true,"origin":"","legend":"\u003cp\u003eMale, 39 years old, right calcaneal fracture.After the talus and calcaneus was distracted，After the talus and calcaneus were distracted, the tarsal sinus incision was made and then fixed with absorbable screws combined with cannulated screws.\u003c/p\u003e\n\u003cp\u003ea:talus-calcaneal distraction,b:tarsal sinus incision, c:lateral x-ray of the calcaneus,d:a xial X-ray of calcaneus,e: lateral X-ray of the calcaneus six month later,f: axial X-ray of the calcaneus six month later,g:3.5mm diameter absorbable screw.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7056109/v1/93d48a483cf31764129f3880.png"},{"id":90114449,"identity":"f52ad077-9331-48a8-bbf4-604a5333d2dd","added_by":"auto","created_at":"2025-08-28 15:53:58","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2001071,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7056109/v1/faf2874b-ae33-4ae7-8ca0-76b36a7d9049.pdf"},{"id":88648799,"identity":"1dbc63fb-16f3-43d4-ad45-92d839acc76e","added_by":"auto","created_at":"2025-08-08 16:55:41","extension":"rar","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":129702312,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryMaterials.rar","url":"https://assets-eu.researchsquare.com/files/rs-7056109/v1/dcf8e936d81097940392fd49.rar"}],"financialInterests":"No competing interests reported.","formattedTitle":"Study on the method of using absorbable screws combined with cannulated screws to treat calcaneal fractures using talar calcaneal distraction technique","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCalcaneal fractures account for 1% - 4% of total body fractures in adults, with the most common fracture occurring in falling from a height [1 -2 ] . A fracture of the alcaneus usually causes by a high energy injury , 60%-80% of a fracture of the alcaneus causes an intra-articular fracture , and the \u0026nbsp;displacement of the joint surface seriously affects the function of the hindfoot[3-6] . The calcaneus is the largest tarsal bone in the human foot and has four articular surfaces and The posterior articular surface is the main weight-bearing surface. Fractures through the posterior articular surface are often difficult to anatomically reduce, and there are many controversies in the surgical treatment method［7］.The standard surgical approach for calcaneal fractures is open reduction and internal fixation through an extended L-shaped lateral incision. Although this approach provides good fracture exposure and allows fracture reduction under direct vision, it is associated with a high rate of postoperative soft tissue complications ［8-9］.Limited open reduction and internal fixation is one of the most widely used minimally invasive techniques for the treatment of calcaneal fractures in clinical practice.In particular, limited open reduction and internal fixation via the tarsal sinus incision has the advantage that the minimally invasive incision via the lateral tarsal sinus can effectively expose the subtalar articular surface and perform reduction operations on the articular surface under direct vision.However, this approach cannot fully expose the posterolateral surface of the calcaneus, which increases the difficulty of restoring the height and width of the calcaneus during surgery. It is also more likely to damage the sural nerve, especially when removing the fixation device removing[10].We used the talar calcaneal distraction technique to treat Sanders type II and III intra-articular calcaneal fractures using absorbable screws combined with hollow screws, which effectively solved the technical shortcomings of the traditional tarsal sinus incision and achieved significant clinical efficacy.This paper reported a comparison of the clinical efficacy of 35 cases of Sanders II and III calcaneal fractures treated in our department from January 2022 to June 2024, which were treated by first distracting the calcaneus and talus and then fixing with a steel plate through a tarsal sinus incision and first distracting the calcaneus and talus and then using absorbable screws combined with hollow screws through a tarsal sinus incision.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e\u003cstrong\u003e1. Inclusion and Exclusion Criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Inclusion criteria: (1) Patients who met the diagnostic criteria for calcaneal fractures[\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]; (2) Patients with intra-articular calcaneal fractures, articular surface collapse\u0026thinsp;\u0026gt;\u0026thinsp;2 mm and/or articular surface separation\u0026thinsp;\u0026gt;\u0026thinsp;3 mm as shown by CT scans; (3) Patients with a significant increase in calcaneal width or a significant decrease in height; (4) Sanders II or III calcaneal fractures; (5) Patients with clear consciousness and ability to express themselves clearly; (6) Patients aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2. Exclusion criteria: (1) patients aged\u0026thinsp;\u0026lt;\u0026thinsp;18 years; (2) patients with open fractures; (3) patients with soft tissue abrasions of the heel; (4) patients with soft tissue infections around the heel; (5) patients with pathological fractures; (6) patients with vascular diseases of the lower limbs; (7) patients with clear contraindications to surgery and unable to tolerate surgery; (8) patients with fractures in other parts of the lower limbs.\u003c/p\u003e\n\u003ch3\u003e2. Materials and methods\u003c/h3\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003e2.1 General information\u003c/h2\u003e\n\u003cp\u003eAmong the 35 cases included, 33 were males, including one with bilateral fractures, and 2 were females; the average age was (46.72\u0026thinsp;\u0026plusmn;\u0026thinsp;8.56) years old. The fractures were unilateral or bilateral, with 17 cases on the right side and 19 cases on the left side.The time of injury ranged from 5 to 120 hours, with an average of (27.34\u0026thinsp;\u0026plusmn;\u0026thinsp;10.88) hours. The preoperative time was from 2 to 17days (7.43\u0026thinsp;\u0026plusmn;\u0026thinsp;3.85), and the cause of injury was: 31 cases of falling from height and 5 cases of traffic injury. Sanders fracture classification: 11 cases of type II and 25 cases of type III. The preoperative B\u0026ouml;hler angle was 2.1\u0026deg;ཞ40.1\u0026deg;, with an average of (9.82\u0026thinsp;\u0026plusmn;\u0026thinsp;8.47)\u0026deg;; the Gissane angle was 95.3\u0026deg;ཞ138.0\u0026deg;, with an average of (111.68\u0026thinsp;\u0026plusmn;\u0026thinsp;14.44)\u0026deg;.; Calcaneus height 34.1\u0026thinsp;~\u0026thinsp;47.7 mm, average (48.12\u0026thinsp;\u0026plusmn;\u0026thinsp;4.14) mm; Calcaneus width 36.8\u0026thinsp;~\u0026thinsp;53.3 mm, average (42.27\u0026thinsp;\u0026plusmn;\u0026thinsp;2.70) mm.All patients were randomly divided into two groups: calcaneal talar distraction tarsal sinus incision plate fixation and calcaneal talar distraction tarsal sinus incision absorbable screw combined with cannulated screw. There were 17 cases in the tarsal sinus incision plate fixation group and 19 cases in the tarsal sinus incision absorbable screw combined with cannulated screw group. There was no significant difference in age, gender, side, Sanders classification, injury time, preoperative B\u0026ouml;hler angle, Gissane angle, calcaneal height and width between the two groups (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n\u003ch2\u003e2.2 Surgical method\u003c/h2\u003e\n\u003cp\u003eEpidural anesthesia. The patient lies on the healthy side (both feet can be prone). ① Group A: From 2 cm below the tip of the lateral malleolus to the base of the fourth metatarsal, a 4\u0026ndash;6 cm incision is made to expose the lateral wall of the calcaneus and the subtalar articular surface.A 2.5mm diameter Kirschner wire was placed behind the talar neck and calcaneal tuberosity. A distractor was used to place the wires on the inside and outside of the calcaneus. The inside distractor was used to distract the calcaneus to correct calcaneal varus. The outside distractor was used to distract the calcaneus slightly to correct the shortening and height of the calcaneus. The articular surface fracture was then repositioned.If there is a protrusion on the lateral wall of the calcaneus, use a compressor to correct the protrusion and width of the calcaneus. After loosening the lateral wall of the calcaneus, fix the repositioned calcaneus with a tarsal sinus plate (anatomical locking plate (Jiangsu Xinrong Bolt Medical Equipment Co., Ltd.)), flush it, and suture the incision in layers.\u003c/p\u003e\n\u003cp\u003e② Epidural anesthesia. The patient was placed in the normal side lying position (both feet were placed in the prone position). ① Group B: From 2 cm below the tip of the lateral malleolus to the base of the fourth metatarsal, a 4\u0026ndash;6 cm incision was made to expose the lateral wall of the calcaneus and the subtalar articular surface.A 2.5mm diameter Kirschner wire is placed at the posterior and inferior part of the talar neck and calcaneal tuberosity, respectively. A distractor is used to place the wires on the medial and lateral sides of the calcaneus. The medial distractor is used to distract the calcaneus to correct calcaneal varus. At the same time, the lateral distractor is used to distract the calcaneus slightly. Together with the medial distractor, the shortening and height of the calcaneus are corrected. The joint surface is then repositioned. If there is a protrusion on the lateral wall of the calcaneus, a compressor is used to correct the protrusion and width of the calcaneus.A 6.0 mm diameter hollow screw (metal hollow bone screw (Jiangsu Baiyide Medical Technology Co., Ltd.)) was implanted from the inner and outer sides of the posterior calcaneus to the inner and outer sides respectively to maintain the height and length of the calcaneus. A 3.5 mm diameter absorbable screw (Chengdu Dikang Zhongke Biomedical Materials Co., Ltd.) was used to fix the reduced joint surface. After flushing, the incision was sutured in layers.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n\u003ch2\u003e2.3 Postoperative treatment\u003c/h2\u003e\n\u003cp\u003eElevate the affected foot. Start foot and ankle active and passive functional exercises 2 days after surgery. Remove sutures after 2 weeks, gradually start weight-bearing activities after 8 weeks, and fully weight-bearing after 12 weeks. Take lateral and axial heel X-rays after surgery to evaluate the effect of surgical reduction.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n\u003ch2\u003e2.4 Statistical analysis\u003c/h2\u003e\n\u003cp\u003eSPSS 20.0 software was used for statistical analysis. Measurement data were expressed as X\u003csup\u003e\u0026minus;\u003c/sup\u003e\u0026plusmn;s. Inter-group comparisons were performed using independent sample t-tests, and t\u0026prime;-tests were used when variances were unequal; intra-group comparisons were performed using paired t-tests; and enumeration data were compared using \u0026chi;2 tests.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAll patients were followed up for 3 to 12 (6.25\u0026thinsp;\u0026plusmn;\u0026thinsp;3.39) months in group A and 4 to 17 (6.58\u0026thinsp;\u0026plusmn;\u0026thinsp;4.09) months in group B. One case in group A had delayed healing of the skin incision edge, which was cured after wound dressing.One case in group B had delayed healing of the skin incision edge, which was cured after wound dressing.There was no statistically significant difference in complications between the two groups (P \u0026gt;0.05).Imaging examinations showed that the fractures in both groups were basically healed 3 months after surgery.At the last follow-up, the calcaneal width, calcaneal height, Bohler angle and Gissane angle of the two groups were significantly different from those before surgery (P \u0026lt; 0.05), see Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e;There was no statistically significant difference in the preoperative calcaneal width, calcaneal height, B\u0026ouml;hler angle and Gissane angle between the two groups (P \u0026gt;0.05), see Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e;There were no statistically significant differences in calcaneal width, calcaneal height, B\u0026ouml;hler angle, Gissane angle, and AOFAS score between the two groups at the last follow-up (P \u0026gt;0.05), see Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e.Two groups of typical cases are shown in Figs.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and Figs.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eComparison of calcaneal width, height and B\u0026ouml;hler angle between the two groups before surgery and at the last follow-up\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003etime\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eCalcaneus width\u003c/p\u003e\n\u003cp\u003e(mm)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"6\" align=\"left\"\u003e\n\u003cp\u003eCalcaneus height\u003c/p\u003e\n\u003cp\u003e(mm)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003eGissane Corner\u003c/p\u003e\n\u003cp\u003e(\u0026deg;)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eB\u0026ouml;hler\u003c/p\u003e\n\u003cp\u003eCorner\u003c/p\u003e\n\u003cp\u003e(\u0026deg;)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup A(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eGroup B(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eGroup A(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eGroup B(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003eGroup A\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup B\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003eGroup A\u003c/p\u003e\n\u003cp\u003e(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup B(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eProperative\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e36.8ཞ53.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e39.0ཞ56.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.4ཞ47.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"5\" align=\"left\"\u003e\n\u003cp\u003e32.6ཞ45.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e95.3ཞ130.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e83.5ཞ134.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e16.5ཞ36.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.1ཞ29.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e45.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e40.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e39.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e118.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e114.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e26.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e20.88\u0026thinsp;\u0026plusmn;\u0026thinsp;8.91\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eLast follow-up\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.8ཞ44.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e35.9ཞ45.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e37.6ཞ47.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e36.3ཞ51.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e98.3ཞ126.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e107.8ཞ142.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e26.2ཞ43.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.8ཞ39.9\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e41.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e44.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e42.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e110.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e122.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e21.85\u0026thinsp;\u0026plusmn;\u0026thinsp;8.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.45\u0026thinsp;\u0026plusmn;\u0026thinsp;5.41\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e3.97\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e2.71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e\u0026minus;2.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u0026minus;2.20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"4\" align=\"left\"\u003e\n\u003cp\u003e2.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.54\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e\u0026minus;2.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e-4.37\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.00045\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.01\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.038\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.03\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"3\" align=\"left\"\u003e\n\u003cp\u003e0.016\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.02\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e0.0001\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003ePreoperative calcaneal width, calcaneal height, B\u0026ouml;hler angle and Gissane angle of the two groups\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGroup\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCalcaneus width\u003c/p\u003e\n\u003cp\u003e(mm)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCalcaneus height\u003c/p\u003e\n\u003cp\u003e(mm)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGissane Corner\u003c/p\u003e\n\u003cp\u003e(\u0026deg;)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u0026ouml;hler Corner\u003c/p\u003e\n\u003cp\u003e(\u0026deg;)\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eA\u003c/p\u003e\n\u003cp\u003egroup(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.8ཞ53.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.4ཞ47.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e95.3ཞ130.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e16.5ཞ36.2\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e46.6\u0026thinsp;\u0026plusmn;\u0026thinsp;5.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e118.7\u0026thinsp;\u0026plusmn;\u0026thinsp;10.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.9\u0026thinsp;\u0026plusmn;\u0026thinsp;7.0\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eB\u003c/p\u003e\n\u003cp\u003egroup(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.0ཞ56.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e32.6ཞ45.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e83.5ཞ134.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e2.1ཞ29.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e114.1\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.9\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.150\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e1.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;1.47\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.54\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.150\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.14\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.15\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.59\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003cdiv class=\"colspec\" align=\"left\"\u003e\u0026nbsp;\u003c/div\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eThe calcaneal width, calcaneal height, B\u0026ouml;hler angle, Gissane angle and AOFAS score of the two groups at the last follow-up\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCalcaneus width\u003c/p\u003e\n\u003cp\u003e(mm)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eCalcaneus height\u003c/p\u003e\n\u003cp\u003e(mm)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eGissane Corner\u003c/p\u003e\n\u003cp\u003e(\u0026deg;)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eB\u0026ouml;hler\u003c/p\u003e\n\u003cp\u003eCorner\u003c/p\u003e\n\u003cp\u003e(\u0026deg;)\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eAOFAS score\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eA group(n\u0026thinsp;=\u0026thinsp;16)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.8ཞ44.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e37.6ཞ47.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e98.3ཞ126.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e26.2ཞ43.6\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e76ཞ94\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e40.1\u0026thinsp;\u0026plusmn;\u0026thinsp;3.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e44.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e110.1\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e21.85\u0026thinsp;\u0026plusmn;\u0026thinsp;8.84\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e86.31\u0026thinsp;\u0026plusmn;\u0026thinsp;5.00\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eB group(n\u0026thinsp;=\u0026thinsp;19)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e39.0ཞ56.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e36.3ཞ51.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e107.8ཞ142.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e19.8ཞ39.9\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e79ཞ93\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e45.9\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e42.7\u0026thinsp;\u0026plusmn;\u0026thinsp;4.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e122.8\u0026thinsp;\u0026plusmn;\u0026thinsp;7.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e31.45\u0026thinsp;\u0026plusmn;\u0026thinsp;5.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e85.26\u0026thinsp;\u0026plusmn;\u0026thinsp;5.01\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003et-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;1.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.499\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;1.78\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026minus;0.48\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.639\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ep-value\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.195\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.621\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.084\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.63\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0.526\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe optimal treatment for calcaneal fractures remains controversial, especially intra-articular fractures with displacement of the posterior articular surface of the calcaneus. An increasing number of studies have shown that surgical treatment tends to improve functional outcomes compared with nonoperative treatment［11］.The key points of surgical treatment of comminuted calcaneal fractures are to restore the flatness of the talocervical joint surface, the Bühler angle and the calcaneal height［12］.Sanders type II and III intra-articular calcaneal fractures have a high disability rate. For calcaneal fractures with a displacement of more than 2 mm of the posterior subtalar articular surface, surgical treatment can achieve better imaging results and clinical efficacy than non-surgical treatment [13]. However, due to complications, there is still no consensus on the standard treatment approach [14-15].Although the L-shaped incision on the lateral side of the calcaneus provides a good visual field, it is prone to complications such as infection, skin edge necrosis, wound nonhealing, and osteomyelitis due to extensive stripping of the periosteum and skin flap during the operation [16].Around the tarsal sinus incision, the terminal branches of the peroneal artery anastomose with surrounding blood vessels to form a rich vascular network. The effect of the tarsal sinus incision on the surrounding blood supply is significantly less than that of the lateral expanded L-shaped incision. The incidence of soft tissue complications decreases as the incision becomes smaller [17].The tarsal sinus incision can directly expose the subtalar articular surface and the calcaneus cuboid joint, which can accurately reduce the articular surface and achieve a strong internal fixation effect when combined with hollow screw fixation.［18］The tarsal sinus approach has advantages over the lateral extended “L” approach in terms of preoperative waiting time, operation time, incision length, postoperative drainage volume, and VAS score[19-23].According to LiS, iatrogenic sural nerve injury occurred in 5 of 52 patients (9.6%) following the sinus tarsi approach\u0026nbsp;[24].When screws or sinus tarsi plates are used via the sinus tarsi approach, removal of the internal fixation after fracture healing poses a risk to the sural nerve. This is because the sural nerve often lies within the scar tissue of the incision, making it difficult to expose; once exposed, dissection of the nerve increases the likelihood of iatrogenic injury.When we use absorbable screws to fix articular surface fractures during surgery, we only need to expose the upper part of the lateral wall of the calcaneus. There is no need to widely dissect the lateral wall of the calcaneus as when using a tarsal sinus plate.Two screws with a diameter of 6.0 mm: the outer screw is fixed from the posterior inferior to the front to maintain the length of the calcaneus and prevent calcaneal inversion; the inner screw is fixed from the posterior inner to the medial superior to maintain the height of the calcaneus. In this way, the 6.0 mm screws and the absorbable screws together form a framework structure to maintain the calcaneal fracture, thereby achieving the fixation effect.After the fracture heals, there is no need to make an incision in the tarsal sinus area because the absorbable screws are absorbed, thus avoiding the risk of sural nerve injury, wound healing risk and infection risk when the fixation device is removed.When removing the two posterior hollow screws with a diameter of 6.0 mm, they are located at the rear and are easy to expose. They can be implanted inside the hollow screws under Kirschner wire detection, avoiding incision complications.\u003c/p\u003e\n\u003cp\u003eRestoring the calcaneal inversion, length, height, width and flatness of the articular surface, that is, restoring the anatomical morphology of the calcaneus to the greatest extent, is the core of surgical treatment of calcaneal fractures.How to restore the length, height, width and flatness of the articular surface of the calcaneus is the key to a successful operation.Calcaneal fractures often present with inversion. The misalignment of the hindfoot force line causes inversion and varus deformity of the hindfoot, which directly leads to early failure of calcaneal fracture treatment and requires long-term calcaneal osteotomy or subtalar joint fusion to relieve clinical symptoms [25-26].Loss of calcaneal height will lead to a widening of the calcaneal width, which may result in impingement of the lateral calcaneus with the peroneal tendons after calcaneal fracture surgery, even if good reduction of the subtalar articular surface is achieved [27].In the past, the tarsal sinus approach was used to correct force alignment, especially calcaneal varus. During the operation, a Steinmann wire was inserted through the calcaneal tuberosity for manual traction, prying, and compression. Since the medial structure of the calcaneus cannot be directly exposed, this operation requires the surgeon to have sufficient understanding of the anatomical structure of the calcaneus, sufficient preoperative planning, and considerable experience in calcaneal reduction surgery, so it places high demands on the surgeon.During the operation, we used Kirschner wires to implant the calcaneal tuberosity and talus, and then used a distractor to distract the calcaneus. The advantage is that it gradually and continuously distracts the medial column, which is not only conducive to correcting calcaneal varus, but also effectively restores the length, height and width of the calcaneus in combination with mild lateral distraction.After restoring the length, height, and width of the calcaneus, the distractor can continue to stabilize the reduction until we fix the fracture with screws.\u003c/p\u003e\n\u003cp\u003eAlthough this method is easy to operate, it requires the implantation of Kirschner wires on the talus, which poses a risk of affecting the blood supply to the talus. In addition, although the Kirschner wires effectively avoid important structures such as the ankle canal when implanted at the calcaneal tuberosity, they cause damage to skin and soft tissues such as the calcaneal fat pad, increasing the risk of postoperative wound infection.\u003c/p\u003e\n\u003cp\u003eIn summary, the talar calcaneal distraction using absorbable screws combined with cannulated screws for the treatment of Sanders II and III calcaneal fractures through the tarsal sinus incision is effective.It has the advantages of less trauma, full exposure of the subtalar joint surface, effective correction of calcaneal force line, and low incidence of postoperative incision complications, and is a recommended treatment method. However, this technology is not suitable for Sanders IV type calcaneal fractures, and the surgical technique learning curve is long, so junior physicians need to be cautious in choosing.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eYW\u0026nbsp;\u003c/strong\u003edesigned the study and wrote the paper. YZ, CW and LD collected the clinical data.All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHelsinki. The information of all participants was collected after obtaining\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ewritten informed consent. This study was approved by the Ethics Committee of the Linyi First People\u0026apos;s Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEpstein N, Chandran S, Chou L. Current concepts review: intra-articular fractures of the calcaneus. Foot Ankle Int. 2012;33(1):79\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3113/FAI.2012.0079\u003c/span\u003e\u003cspan address=\"10.3113/FAI.2012.0079\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMordecai SC, Ray PS. 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Foot Ankle Int. 2011;32(8):789\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3113/FAI.2011.0789\u003c/span\u003e\u003cspan address=\"10.3113/FAI.2011.0789\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003e\u0026amp;#57361.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"calcaneal fracture, calcaneal-talar distraction, absorbable screw, cannulated screw","lastPublishedDoi":"10.21203/rs.3.rs-7056109/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7056109/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: For intra-articular fractures with displaced posterior articular surface of calcaneus, more and more studies have shown that surgical treatment has better functional outcomes than non-surgical treatment. However, it is difficult to correct calcaneal inversion and restore calcaneal length and width during surgery, and traditional fracture fixation methods have many problems. The aim of this study was to explore the method of treating calcaneal fractures by using talar calcaneal distraction technique and absorbable screws combined with cannulated screws through a tarsal sinus incision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eThirty-five patients with Sanders Ⅱ and Ⅲ calcaneal fractures were divided into two groups according to the treatment methods. The patients were treated with calcaneal talar distraction technique through tarsal sinus incision with plate fixation (17 cases) and calcaneal talar distraction through tarsal sinus incision with absorbable screws combined with cannulated screws (19 cases).The height, width, Böhler\u003c/p\u003e\n\u003cp\u003eangle, and Gissane angle of the calcaneus were measured preoperative, postoperative and at the last follow-up. The AOFAS score of the ankle joint was recorded at the last follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e \u0026nbsp;All 35 patients were followed up for 10-17 (13.19 ± 1.47) months in group A and 9-18 (13.45 ± 2.80) months in group B. At the last follow-up, the calcaneal height, width, Böhler angle and Gissane angleof the two groups were significantly improved compared with those before surgery, and the differences were statistically significant (P ＜ 0.05); there was no statistically significant difference between the two groups (P ＞0.05). There was no statistically significant difference in AOFAS scores between the two groups (P ＞0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003eThe calcaneal-talar distraction technique using absorbable screws combined with hollow screws through the tarsal sinus incision to treat calcaneal fractures has the advantages of less trauma, simple reduction, and fewer complications. Its efficacy is equivalent to that of the traditional tarsal sinus incision using steel plates for fixation.\u003c/p\u003e","manuscriptTitle":"Study on the method of using absorbable screws combined with cannulated screws to treat calcaneal fractures using talar calcaneal distraction technique","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-08 16:55:30","doi":"10.21203/rs.3.rs-7056109/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ae1a3305-9c7e-4a8d-84fb-5cd269d7948e","owner":[],"postedDate":"August 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-08-28T15:53:47+00:00","versionOfRecord":[],"versionCreatedAt":"2025-08-08 16:55:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7056109","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7056109","identity":"rs-7056109","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}