{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T07:16:38Z","timestamp":1789456598772,"version":"build-2803163510"},"reference-count":38,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T00:00:00Z","timestamp":1782172800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["International Orthopaedics (SICOT)"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The optimal surgical approach for displaced intra-articular calcaneal fractures remains contentious. While minimally invasive surgery (MIS) reduces soft-tissue complications, its application in complex fractures is debated. Ligamentotaxis, a cornerstone of MIS, requires an intact calcaneal tuberosity as a fulcrum. This study evaluates the utility of preoperative tuberosity integrity assessment in guiding surgical approach selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective case\u2013control study, 118 patients (2019\u20132022) were allocated to two treatment algorithms due to an institutional protocol evolution. Group A (Sanders-guided, n\u2009=\u200951) received MIS for Sanders type II\/III and ELA for type IV. Group B (tuberosity-guided, n\u2009=\u200967) received MIS if the tuberosity was intact or an extended lateral approach (ELA) if comminuted. Outcomes included operative metrics, radiographic reduction (B\u00f6hler\u2019s angle, facet step-off), functional scores (AOFAS, Maryland Foot Score), VAS pain scores, and complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      No significant differences were observed in radiographic or functional outcomes between the two groups. However, the tuberosity-guided approach suggested a potential reduction in operative time for fractures with comminuted tuberosity (93.5\u2009\u00b1\u20096.1\u00a0min vs. 103.2\u2009\u00b1\u20094.7\u00a0min, p\u2009=\u20090.017, a preliminary finding due to the small sample size). Analysis of the entire cohort (n\u2009=\u2009118) revealed that the wound complication rate was notably higher when comminuted tuberosity fractures were treated with STA (2\/2, 100%) compared to ELA (1\/9, 11.1%, p\u2009=\u20090.011). Furthermore, among all STA cases, patients with comminuted tuberosity had a markedly higher observed complication rate than those with intact tuberosity (100% vs. 9.5%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Preoperative assessment of calcaneal tuberosity integrity offers a potentially valuable adjunct to the Sanders classification for selecting the surgical approach in displaced intra-articular calcaneal fractures. It achieves comparable clinical outcomes. Given the exploratory nature of subgroup analyses based on a limited number of comminuted fractures, the findings regarding enhanced operative efficiency and complication profiles are preliminary and require validation in larger, prospective cohorts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00264-026-06927-8","type":"journal-article","created":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T09:18:07Z","timestamp":1782206287000},"page":"1787-1797","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The guiding significance of calcaneal tuberosity integrity in the surgical treatment of calcaneal fractures: a retrospective case\u2013control study"],"prefix":"10.1007","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9129-6254","authenticated-orcid":false,"given":"Gang","family":"Luo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xing","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zenghui","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weidong","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"issue":"5","key":"6927_CR1","doi-asserted-by":"publisher","first-page":"443","DOI":"10.1016\/j.injury.2003.10.006","volume":"35","author":"S Rammelt","year":"2004","unstructured":"Rammelt S, Zwipp H (2004) Calcaneus fractures: facts, controversies and recent developments. 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