Hand-assisted placement of sustentaculum tali screws using surface anatomical landmarks in calcaneal fracture fixation

Objective To describe a hand-assisted technique for sustentaculum tali (ST) screw placement using surface anatomical landmarks and evaluate screw placement accuracy and procedural characteristics in patients with calcaneal fractures. Methods This retrospective study included 126 patients with Sanders type III or IV calcaneal fractures (134 feet) who underwent open reduction and internal fixation at the Department of Orthopedics, Second Hospital of Shanxi Medical University, between October 2022 and October 2024. ST screws were inserted using a hand-assisted technique guided by surface anatomical landmarks. ST screw placement time, the number of fluoroscopic exposures during guidewire positioning, and guidewire adjustments were recorded for each screw. Postoperative computed tomography (CT) was used to assess screw position and trajectory according to predefined criteria. Results Postoperative CT showed that 124 of 134 ST screws (92.54%) met the predefined criteria for acceptable placement. The remaining 10 screws showed cortical breaches, including 8 anterosuperior and 2 posteroinferior breaches. The mean ST screw placement time was 1.92 ± 0.86 min per screw, and the mean number of fluoroscopic exposures during guidewire positioning was 3.06 ± 1.28 per screw. Following the initial fluoroscopic assessment, 14 screws (10.45%, 14/134) required repositioning. The mean number of repositioning attempts across all screws was 0.14 ± 0.44 per screw. Conclusion Hand-assisted ST screw placement guided by surface anatomical landmarks may be considered an option for internal fixation of calcaneal fractures.