Two internal fixation methods for Sanders type II-IV calcaneal fractures: a 2-year clinical follow-up and finite element analysis

doi:10.12307/2026.152

Abstract

Abstract: BACKGROUND: For Sanders II-IV type calcaneal fractures, traditional plate fixation is effective but invasive, while minimally invasive cannulated screw fixation has become a research hotspot in recent years due to its advantages in reducing soft tissue damage and trauma.
OBJECTIVE: To evaluate the clinical efficacy and biomechanical properties of cannulated screw closed reduction technology with spatial weaving technique versus traditional plate fixation in the treatment of Sanders type II-IV calcaneal fractures.
METHODS: This study used a combination of clinical case analysis and finite element analysis. A total of 34 patients with Sanders type II-IV calcaneal fractures who were treated at Zunyi First People's Hospital from January 2022 to June 2024 were randomly divided into two groups (n=17). The cannulated screw group received percutaneous cannulated screw fixation with spatial weaving technique. The plate group received sinus tarsi approach with plate screw fixation. Operation time, intraoperative blood loss, incision length, hospital stay, fracture healing time, visual analog scale pain score, American Orthopedic Foot & Ankle Society ankle-hindfoot score, and economic benefits were compared between the two groups. Additionally, 64-row spiral CT scans were used to construct 3D models of calcaneal-hollow screw and calcaneal-plate assemblies. Mesh division and finite element analysis were performed using Hypermesh 14.0 and Abaqus 6.14 software to evaluate the biomechanical performance of the different fixation methods.
RESULTS AND CONCLUSION: (1) Clinical indicators: The cannulated screw group showed significant advantages in operation time (P=0.002), intraoperative blood loss (P < 0.001), and incision length (P < 0.001) compared with the plate group. Postoperative follow-up results showed that the visual analog scale score and American Orthopedic Foot & Ankle Society ankle-hindfoot score were consistently better in the cannulated screw group compared with the plate group (P < 0.05), indicating that the cannulated screw fixation was more effective in reducing pain and improving functional recovery. (2) Finite element analysis: The cannulated screw group showed significantly lower maximum stress and maximum displacement compared with the plate group, with a more uniform stress distribution, suggesting better performance in maintaining fracture stability. (3) Economic benefits: The material cost (P < 0.001) and total hospitalization cost (P < 0.001) were significantly lower in the cannulated screw group than in the plate group. (4) It is indicated that compared with traditional plate fixation, the cannulated screw closed reduction technology shows significant advantages in treating Sanders type II–IV calcaneal fractures. These advantages include reduced trauma, shorter recovery time, fewer complications, improved biomechanical stability, and enhanced cost-effectiveness. This provides new evidence supporting minimally invasive treatment and merits further promotion and application.

Key words: calcaneal fracture, spatial weaving technique, cannulated screw, plate, internal fixation, finite element analysis, biomechanics

CLC Number:

Xiang Hao, Li Yuwan, Xu Zhi, Li Guichuan, Liao Wei, Cai Peng, Zhu Chengxing, Yan Ling. Two internal fixation methods for Sanders type II-IV calcaneal fractures: a 2-year clinical follow-up and finite element analysis[J]. Chinese Journal of Tissue Engineering Research, 2026, 30(15): 3791-3800.

Figures/Tables 6

2.1.5 不良事件此次研究对所有接受治疗的34例患者进行了详细的术后随访和不良事件监测。空心钉组和钢板组均未报告严重的植入物相关不良事件，未见两组患者出现植入物周围感染、过敏反应、免疫反应或排斥反应，表明两种内固定方式的生物相容性良好。空心钉组中无皮肤坏死(0/17)，而钢板组中有1例(1/16)报告了轻微的皮肤坏死，但通过保守治疗得到了控制。此外，两组均未发现螺钉松动或断裂的情况。提示经皮空心钉内固定和跗骨窦入路钢板内固定均为安全可靠的治疗方法。 2.2 有限元分析结果 2.2.1 不同模型跟骨骨折块和内固定系统应力比较如表5及图5，6所示，Sanders Ⅱ型跟骨骨折-空心钉模型跟骨、Sanders Ⅲ型跟骨骨折-空心钉模型跟骨、Sanders Ⅳ型跟骨骨折-空心钉模型跟骨的最大应力均出现在跟骨后突近端隧道孔入口处，最大数值分别为61.2，48.3和62.6 MPa。应力云图显示跟骨骨折块整体应力水平较低，大部分区域的应力水平低于56 MPa，故发生病理性骨折的风险较低，应力水平相对较高的区域分布于跟骨后突与中段骨折块的骨折线附近。在上述3个模型中的空心钉最大应力出现在矢状面方向交叉螺钉中后段的上表面，数值大小分别为232.5，191.3和181.8 MPa。与股骨应力分布的规律相似，空心钉表面整体的应力水平较低，所有区域的应力均小于600 MPa，因此该结构排布空心钉发生断裂的风险较小。Sanders Ⅱ型跟骨骨折-钢板系统模型跟骨、Sanders Ⅲ型跟骨骨折-钢板系统模型跟骨、Sanders Ⅳ型跟骨骨折-钢板系统模型跟骨的最大应力均出现在跟骨后突骨折块与中段骨折块接触的远端骨折面上，最大数值分别为6 832.0，271.3和231.8 MPa。应力云图显示3个模型跟骨后突骨折块和中段外侧骨折块后方以钉道为中心放射到周边区域的大范围高应力区，其中后突骨折块近端钉道口和骨折面接触部位发生疲劳性骨折的风险较高。在上述3个模型中的锁定钢板最大应力均出现在靠近后方骨折线的近端螺钉孔上，数值大小分别为8 995，8 898和8 890 MPa。锁定钢板的后突一侧发生较大形变，该侧钢板主体大部分区域应力高于600 MPa，提示该区域在实际场景中或已断裂失效。"

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