Computational Modelling of Calcaneal Fracture Fixations: A Systematic Scoping Review

Calcaneal fractures are among the most debilitating and costly orthopedic injuries, presenting significant management challenges and poor long-term outcomes. Open reduction and internal fixation (ORIF) remains the gold standard for complex displaced intra-articular fractures, yet high wound complication rates have driven the development of minimally invasive fixation (MIF) techniques. This review systematically evaluates the role of finite element (FE) analysis in calcaneal fracture fixation research, focusing on methodological approaches, model configurations, and reported limitations. A comprehensive search of PubMed, Web of Science, Scopus, and IEEE Xplore identified 23 studies involving 59 computational models derived from 30 subjects. Sanders Type IIB and IIIAB fractures were the most studied due to their clinical relevance and modelling feasibility. FE analyses have progressed from basic stress distribution studies to advanced comparative evaluations and topology-optimized implant designs. Findings indicated that MIF, particularly with supplementary percutaneous screws, offers biomechanical performance comparable to ORIF. However, limitations include reliance on single-subject surrogate models, oversimplified static loading conditions, and limited transparency in model validation. Future research should prioritize multi-patient models, sensitivity analyses of fracture patterns using statistical or generative geometrical approaches, and dynamic loading scenarios (e.g., heel-strike, lunge, fall) to enhance applicability and robustness of findings.