• Stoyan Ivanov, Aleksandar Stefanov, Ivan Zderic, Christian Rodemund, Tim Schepers, Dominic Gehweiler, Jan Dauwe, Torsten Pastor, Biser Makelov, Dimitur Raykov, Geoff Richards, and Boyko Gueorguiev.
• AO Research Institute Davos, Davos, Switzerland. dr.ton.ivanov@gmail.com.
• Eur J Trauma Emerg Surg. 2022 Aug 1; 48 (4): 3305-3315.

PurposeThe aim of this study was to assess the biomechanical performance of different screw configurations for fixation of Sanders type II B joint-depression calcaneal fractures.MethodsFifteen human cadaveric lower limbs were amputated and Sanders II B fractures were simulated. The specimens were randomized to three groups for fixation with different screw configurations. The calcanei in Group 1 were treated with two parallel longitudinal screws, entering superiorly the Achilles tendon insertion, and two screws fixing the intraarticular posterior facet fracture line. In Group 2 two screws entered the tuberosity inferiorly to the Achilles tendon insertion and two transverse screws fixed the posterior facet. In Group 3 two screws were inserted along the bone axis, one transverse screw fixed the posterior facet and one oblique screw was inserted from the posteroplantar part of the tuberosity supporting the posterolateral part of the posterior facet. All specimens were biomechanically tested to failure under progressively increasing cyclic loading.ResultsInitial stiffness did not differ significantly between the groups, P = 0.152. Cycles to 2 mm plantar movement were significantly higher in both Group 1 (15,847 ± 5250) and Group 3 (13,323 ± 4363) compared with Group 2 (4875 ± 3480), P ≤ 0.048. No intraarticular displacement was observed in any group during testing.ConclusionsFrom a biomechanical perspective, posterior facet support by means of buttress or superiorly inserted longitudinal screws results in less plantar movement between the calcaneal tuberosity and the anterior fragments. Inferiorly inserted longitudinal screws are associated with bigger interfragmentary movements.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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