Biomechanical Comparison of Screw and Minimally Invasive Locking Plate Fixation for Calcaneal Fracture Stabilization: A Finite Element Analysis and Clinical Study

Abstract The minimally invasive sinus tarsi surgical optimal technique for calcaneus fracture has gained popularity. This study compares the biomechanical performance of the three fixation methods using screw fixaztion-SF, locking compression plate-LCP for two-point (TP) -with and -without tuberosity based on commonly used fracture methods via joint depression (Sander's type II and III). The biomechanical performance of the two fixation methods was performed using finite element (FE) analysis and a comparative clinical study. The 3D FE model of calcaneal fractures was applied for the boundary and loading condition regarding a bearing load with a total weight of half 70 kg (approximately 350 N) during the stand. The safety factor (SF) of TP without tuberosity was 2.04 for type II, while SF of type III was lowest at 1.86, showing lower failure than the TP with tuberosity. The strain on the fracture site compared with the stability of the device in the case of TP with tuberosity fixation has the highest. At the one-year follow-up, Bohler’s angle was significantly higher in the LCP fixation group than in the screw fixation group (P = 0.026), the loss of Gissane’s angle showed no significant differences, and the FAAM score demonstrated significantly better results in the LCP fixation group compared to the screw fixation group (P < 0.001). Therefore, LCP (TP with tuberosity) fixation was an effective stratagem for technique surgery in joint-depression sander's type II and III compared to other techniques.