Efficacy Analysis of Minimally Invasive Intramedullary Calcaneal Nail and Extensile Lateral Approach Plate Internal Fixation in the Treatment of Sanders Type II-III Calcaneal Fractures

Abstract Objective : To compare the clinical efficacy, radiological outcomes, and complication rates of the minimally invasive intramedullary "nail-in-nail" technique versus extensile lateral approach (ELA) plate internal fixation in the treatment of Sanders Type II-III calcaneal fractures. Methods : A retrospective analysis was conducted on 80 patients with Sanders Type II-III calcaneal fractures admitted to our hospital from January 2021 to December 2022. Patients were divided into the nail group (40 cases, treated with minimally invasive intramedullary "nail-in-nail" fixation) and the plate group (40 cases, treated with ELA plate internal fixation). Operative time, hospital stay, time to full weight-bearing, postoperative complications, radiological parameters (Böhler angle, Gissane angle, calcaneal height), and functional scores (AOFAS ankle-hindfoot score, VAS pain score) were compared between the two groups. Results : The nail group showed significantly less intraoperative blood loss (78.2 ± 24.7 mL vs. 150.4 ± 30.1 mL, p < 0.001), fewer fluoroscopic images (6.8 ± 1.5 vs. 11.2 ± 2.1, p < 0.001), and a shorter hospital stay (6.4 ± 1.1 days vs. 9.7 ± 2.3 days, p < 0.001). At 2 days postoperatively, the nail group had lower VAS scores (2.4 ± 0.9 vs. 3.9 ± 1.2, p < 0.001), and at 6 months, higher AOFAS scores (88.5 ± 5.1 vs. 79.3 ± 7.4, p < 0.001). The excellent-to-good rate (defined as AOFAS score ≥ 80 points: excellent = 90–100 points, good = 80–89 points) was 90% in the nail group versus 70% in the plate group (p = 0.030). The complication rate was also significantly lower in the nail group (5% vs. 15%, p = 0.029). Conclusion : In this retrospective comparative study, minimally invasive intramedullary calcaneal nail fixation is associated with favorable short-term clinical outcomes compared to traditional plating, with clear advantages in reducing surgical trauma, radiation exposure, and postoperative complications. This technique may serve as a viable alternative for selected Sanders type II–III fractures, though interpretations should consider the limitations of non-randomized study design.