Bowstring reduction technique combined with cannulated screw fixation for Sanders type II intra-articular calcaneal fractures

Abstract

Abstract Background Calcaneal fractures are the most common tarsal fractures, and displaced intra-articular fractures involving the posterior facet remain challenging for minimally invasive treatment because the achieved reduction is difficult to maintain. This study aimed to evaluate the technical feasibility and early clinical and radiographic outcomes of the bowstring reduction technique combined with cannulated screw fixation for Sanders type II intra-articular calcaneal fractures. Methods This single-center, non-comparative retrospective series included all 31 consecutive patients in whom the bowstring reduction technique was attempted between January 2021 and December 2023. Follow-up ranged from 13 to 24 months. An adjustable traction-support construct was assembled using Steinmann pins, a bandage, and hemostats to maintain reduction during fluoroscopic assessment and percutaneous cannulated screw fixation. Technical feasibility, complications, fracture healing, clinical outcomes, and radiographic outcomes were assessed. Outcomes were summarized descriptively. Results Technical success was achieved in all 31 attempted procedures (31/31, 100%). No procedure was abandoned or converted to another reduction or fixation strategy because satisfactory reduction could not be achieved. The mean operative time was 75.5 ± 8.6 min. All incisions healed uneventfully, and no deep infection or osteomyelitis occurred. At a median follow-up of 17 months (range, 13–24 months), all fractures had united, with no implant loosening or breakage. The mean Gissane’s angle was 110.9 ± 4.2° preoperatively, 127.4 ± 3.5° immediately postoperatively, and 127.1 ± 3.6° at final follow-up. The mean final AOFAS ankle-hindfoot score was 90.9 ± 5.7. Conclusions The bowstring reduction technique was completed in all 31 attempted procedures in this series of Sanders type II intra-articular calcaneal fractures. Its principal contribution is continuously adjustable traction-support that maintains reduction during fluoroscopic assessment and cannulated screw fixation.

The authors' abstract, as published at the source. BMC Musculoskeletal Disorders, 2026 · DOI ↗