Comparison of screw versus locking plate fixation via sinus tarsi approach for displaced intra-articular calcaneal fractures

Background: The optimal treatment of displaced intra-articular calcaneal fractures (DIACF) is controversial. This study compared the fixation stability of screws and locking plates in DIACF treated via the sinus tarsi approach (STA).Methods: We retrospectively evaluated 118 DIACF cases treated via STA and extracted data that could affect treatment outcomes. Loss of Bohler's angle after surgery was measured to compare fixation stability.Results: The loss of Bohler's angles was significantly smaller in the locking plate group than in the screw group (2.6 +/- 2.7 degrees vs. 5.6 +/- 5.3 degrees, P < 0.01). There was no difference in the clinical outcomes between the groups. On multivariate logistic regression analysis, screw fixation was significantly associated with loss of Bohler's angle by > 10 degrees (odds ratio, 8.63; 95% confidence interval, 1.16-64.4; P < 0.05).Conclusions: Locking plate fixation is more reliable than screw fixation for preventing correction loss in DIACF treated via STA. Level of evidence: III (c) 2022 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.