Mid-Term Outcomes of Locking Plate Fixation via an Extensile Lateral Approach for Intra-Articular Calcaneal Fractures: A Retrospective Cohort Study

Abstract

Objective: Displaced intra-articular calcaneal fractures are complex injuries, and optimal surgical management remains debated. We evaluated radiographic and clinical outcomes and complications following locking plate fixation via an extensile lateral approach. Materials and Methods: This retrospective cohort study included 59 patients (64 feet) treated between 2015 and 2019. Fractures were classified according to the Sanders criteria on preoperative CT. Outcomes included Böhler and Gissane angles, the AOFAS hindfoot score, the VAS pain score, and complications. Associations with fracture severity, bone grafting, diabetes, and smoking were analyzed using nonparametric and categorical tests, and correlations were assessed using Spearman analysis. Results: The mean age was 41.8±10.9 years, and the mean follow-up was 22.4±8.7 months. Radiographic parameters improved significantly postoperatively (Böhler angle: 3.3° to 23.2°; Gissane angle: 121.9° to 128.9°; both p<0.001). The mean AOFAS and VAS scores were 83.1±9.2 and 2.6±1.8, respectively. Outcomes differed by Sanders type (AOFAS, p=0.021; VAS, p=0.034), with poorer results in type IV fractures. Bone grafting was not associated with AOFAS or VAS scores (p=0.621 and p=0.588, respectively). The overall complication rate was 21.8% (2 cases of osteomyelitis and 12 wound-related complications). Complications were associated with worse clinical outcomes, diabetes increased the risk of complications, and smoking showed a non-significant trend. The postoperative Böhler angle correlated positively with the AOFAS score and negatively with the VAS score. Conclusion: Locking plate fixation via an extensile lateral approach achieved significant radiographic restoration with acceptable mid-term clinical outcomes. However, functional recovery and complication burden were strongly influenced by patient risk profile and fracture severity, particularly diabetes and Sanders type IV fractures, whereas bone grafting showed no significant effect on mid-term outcomes.