Finite Element Analysis and Clinical Application of Percutaneous Sustentaculum Tali Screw Fixation for Sanders Type II and III Calcaneal Fractures

Finite Element Analysis and Clinical Application of Percutaneous Sustentaculum Tali Screw Fixation for Sanders Type II and III Calcaneal Fractures | 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 Article Finite Element Analysis and Clinical Application of Percutaneous Sustentaculum Tali Screw Fixation for Sanders Type II and III Calcaneal Fractures Xian Li, Hongshi Han, Chengzhi Ha, Chuanwang Huang, Caixia Jin, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7620422/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 09 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted 11 You are reading this latest preprint version Abstract In calcaneal fractures, the percutaneous screw fixation (PSF) is currently considered to be the better choice. The present study establishes a novel percutaneous sustentaculum tali (ST) screw fixation model for Sanders type II and type III calcaneal fractures, assessing construct stability via finite element analysis (FEA) while concurrently evaluating clinical efficacy through postoperative follow-up. This study utilized FEA, based on the Sanders III fracture line model, to compare the stability of internal implants and fracture fragments between the percutaneous ST screw fixation model, the intramedullary nail model, the locking compression plate (LCP), and minimally invasive plate (MIP), thereby evaluating the biomechanical stability of the percutaneous ST screw construct. In parallel, 23 clinical surgical cases of percutaneous ST screw fixation were included. Through postoperative follow-up, the therapeutic effect was observed to jointly verify the effectiveness of percutaneous ST fixation. Regarding the FEA, after stress loading, among the four internal fixation models, the peak von Mises stress within the calcaneus was maximal in the intramedullary nail model and minimal in the ST screw model. Regarding implant-related stresses, the LCP model exhibited the highest von Mises stress, while the percutaneous ST screw model demonstrated the lowest. In parallel, the maximal fragment displacement in every model was below the reference threshold (150 µm). Percutaneous ST screw fixation demonstrates equivalent biomechanical stability compared with the other constructs. In the clinical follow-up, both the AOFAS and MFS indicated good to excellent functional outcomes, and the low VAS values reflected minimal to no pain, collectively confirming satisfactory restoration of foot function. This study, through FEA and postoperative clinical follow-up, validates percutaneous ST screw fixation as a reliable modality for Sanders type II and III calcaneal fractures, thereby providing an evidence-based reference for calcaneal fracture management. Nevertheless, further biomechanical investigations and larger clinical series are warranted for corroboration. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 09 Jan, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 12 Nov, 2025 Reviews received at journal 11 Nov, 2025 Reviewers agreed at journal 08 Nov, 2025 Reviews received at journal 30 Oct, 2025 Reviewers agreed at journal 23 Oct, 2025 Reviewers agreed at journal 22 Oct, 2025 Reviewers invited by journal 21 Oct, 2025 Editor invited by journal 13 Oct, 2025 Editor assigned by journal 09 Oct, 2025 Submission checks completed at journal 20 Sep, 2025 First submitted to journal 20 Sep, 2025 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. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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-7620422","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":537420887,"identity":"20210957-0784-4681-b534-a4fcf3f3a575","order_by":0,"name":"Xian Li","email":"","orcid":"","institution":"Beijing Jishuitan Hospital Liaocheng Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xian","middleName":"","lastName":"Li","suffix":""},{"id":537420888,"identity":"ca4ce7f7-5aff-45d2-8e01-788d21a58cea","order_by":1,"name":"Hongshi Han","email":"","orcid":"","institution":"Shandong First Medical University, Shandong Academy Of Medical 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Fractures","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7620422/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7620422/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn calcaneal fractures, the percutaneous screw fixation (PSF) is currently considered to be the better choice. The present study establishes a novel percutaneous sustentaculum tali (ST) screw fixation model for Sanders type II and type III calcaneal fractures, assessing construct stability via finite element analysis (FEA) while concurrently evaluating clinical efficacy through postoperative follow-up. This study utilized FEA, based on the Sanders III fracture line model, to compare the stability of internal implants and fracture fragments between the percutaneous ST screw fixation model, the intramedullary nail model, the locking compression plate (LCP), and minimally invasive plate (MIP), thereby evaluating the biomechanical stability of the percutaneous ST screw construct. In parallel, 23 clinical surgical cases of percutaneous ST screw fixation were included. Through postoperative follow-up, the therapeutic effect was observed to jointly verify the effectiveness of percutaneous ST fixation.\u003c/p\u003e\u003cp\u003eRegarding the FEA, after stress loading, among the four internal fixation models, the peak von Mises stress within the calcaneus was maximal in the intramedullary nail model and minimal in the ST screw model. Regarding implant-related stresses, the LCP model exhibited the highest von Mises stress, while the percutaneous ST screw model demonstrated the lowest. In parallel, the maximal fragment displacement in every model was below the reference threshold (150 \u0026micro;m). Percutaneous ST screw fixation demonstrates equivalent biomechanical stability compared with the other constructs. In the clinical follow-up, both the AOFAS and MFS indicated good to excellent functional outcomes, and the low VAS values reflected minimal to no pain, collectively confirming satisfactory restoration of foot function. This study, through FEA and postoperative clinical follow-up, validates percutaneous ST screw fixation as a reliable modality for Sanders type II and III calcaneal fractures, thereby providing an evidence-based reference for calcaneal fracture management. Nevertheless, further biomechanical investigations and larger clinical series are warranted for corroboration.\u003c/p\u003e","manuscriptTitle":"Finite Element Analysis and Clinical Application of Percutaneous Sustentaculum Tali Screw Fixation for Sanders Type II and III Calcaneal Fractures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-31 18:31:33","doi":"10.21203/rs.3.rs-7620422/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-11-12T13:00:36+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-11T21:25:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"177541637375581174504480718634050022352","date":"2025-11-08T10:47:32+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-30T10:22:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86944284613934258917804818140541327459","date":"2025-10-23T08:45:10+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"202457883409927935205101278719367872603","date":"2025-10-22T21:21:05+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-21T14:50:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-13T05:46:16+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-09T15:16:24+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-20T15:19:49+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-20T15:16:01+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cab540c8-0eca-43ce-86a0-607caa9f4b41","owner":[],"postedDate":"October 31st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":57153359,"name":"Health sciences/Diseases"},{"id":57153360,"name":"Health sciences/Health care"},{"id":57153361,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2026-01-12T15:59:53+00:00","versionOfRecord":{"articleIdentity":"rs-7620422","link":"https://doi.org/10.1038/s41598-026-35521-6","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-01-09 15:57:02","publishedOnDateReadable":"January 9th, 2026"},"versionCreatedAt":"2025-10-31 18:31:33","video":"","vorDoi":"10.1038/s41598-026-35521-6","vorDoiUrl":"https://doi.org/10.1038/s41598-026-35521-6","workflowStages":[]},"version":"v1","identity":"rs-7620422","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7620422","identity":"rs-7620422","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}