Progressive radiological and clinical outcomes of minimally invasive cannulated cancellous screw fixation in intra-articular calcaneal fractures: a case series

Abstract

Displaced intra-articular calcaneal fractures (DIACFs) pose a significant reconstructive challenge. Minimally invasive cannulated cancellous (CC) screw fixation has emerged as an optimal alternative to extensile lateral plating. This case series analyzes the progressive radiological and clinical outcomes over a 6-month follow-up, evaluating the impact of preoperative deformity severity while highlighting the operational and rehabilitative benefits of the percutaneous approach. A retrospective review was conducted on 16 DIACF cases. Standardized operative maneuvers utilizing Steinmann pin manipulation and CC screw fixation were employed. Serial assessments of Böhler’s angle, Gissane’s angle, Varus angle, and visual analog scale (VAS) pain scores were recorded preoperatively, immediately postoperatively, and at 1, 3, and 6 months. Progressive trends were analyzed using Friedman tests, and patients were stratified by the severity of their preoperative articular depression. Significant progressive corrections were observed across all parameters (p<0.001). Preoperative Böhler’s angle (5.88°±5.30°) improved immediately (26.38°±3.50°) and was sustained at 6 months (26.62°±3.54°). VAS scores plummeted from 8.50±0.73 preoperatively to 0.38±0.50 at 6 months. Subgroup analysis revealed that patients with severe preoperative Böhler’s depression (≤ 0°) achieved massive corrective improvements (mean 24.50°), reaching final outcomes parallel to those with mild initial deformity. CC screw fixation provides robust, sustained restoration of calcaneal anatomy regardless of initial deformity severity. Furthermore, it affords the added benefits of dramatically reduced wound complications, shorter operative times, lower operative morbidity, early rehabilitation, and superior cost-effectiveness compared to traditional open procedures.