Abstract
Calcaneus fractures are common orthopedic injuries, often caused by high-energy impacts such as falls from height or direct trauma. These fractures can result in severe pain, swelling, and dysfunction of the heel. Surgical intervention is essential to reduce the risk of post-traumatic arthritis and restore foot function. However, traditional open surgical approaches can lead to complications such as incision infections and skin necrosis due to the extensive soft tissue exposure required. This randomized controlled trial aimed to assess the clinical efficacy of distractor-assisted, arthroscopy-guided minimally invasive screw fixation for treating Sanders type II and III intra-articular calcaneal fractures. Conducted at Weifang People’s Hospital from February 2022 to February 2024, the study involved 60 patients randomized into two groups: a minimally invasive group (n = 30) and an open reduction group (n = 30). The minimally invasive group received distractor-assisted, arthroscopy-guided reduction with percutaneous screw fixation, while the open group underwent open reduction with plate fixation. Primary outcomes included surgical time, incision length, operative duration, intraoperative blood loss, hospital stay, and fracture healing time. Secondary outcomes involved calcaneal dimensions, functional scores (AOFAS, Maryland Foot Function Score, VAS for pain), and complications at one-year follow-up. At one-year follow-up, all fractures had healed, with an average healing time of 12 weeks. The minimally invasive group showed significant advantages in surgical parameters and pain relief, with no significant differences in functional outcomes. In conclusion, distractor-assisted, arthroscopy-guided minimally invasive screw fixation is an effective, minimally traumatic treatment option for Sanders type II and III calcaneal fractures. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13018-025-05984-w.