Abstract
Background
Displaced intra-articular calcaneal fractures (DIACFs) are among the most challenging hindfoot injuries and are often associated with persistent disability, reduced quality of life, and treatment-related complications [1, 2]. Although extensile lateral open reduction and plate fixation can restore calcaneal anatomy, it is accompanied by substantial soft-tissue morbidity [3-6]. Locking intramedullary nailing (IMN) is less invasive, yet comparative studies often emphasize overall complication rates and long-term functional scores, with limited quantification of perioperative soft-tissue management burden and early recovery trajectories [9, 10].Methods
We performed a retrospective cohort study comparing locking IMN with extensile lateral plating (ORIF) in adults with DIACFs. The primary outcomes were (1) a Soft‑Tissue Burden Index (STBI) incorporating drain utilization, postoperative drainage volume, wound leakage duration, dressing changes, aspiration for hematoma/seroma, and soft‑tissue reintervention; and (2) early recovery trajectories using repeated pain scores (VAS) and patient‑reported outcomes (Foot Function Index, FFI) at prespecified time points (2, 6, and 12 weeks; 6 and 12 months). Confounding was addressed using inverse probability of treatment weighting (IPTW) [13-15, 17].Results
Ninety patients were included (IMN n = 28; ORIF n = 62). After IPTW, baseline covariates were balanced. IMN demonstrated a lower STBI than ORIF (weighted mean 1.3 ± 1.1 vs. 3.5 ± 1.4; p Conclusions
Locking IMN showed lower perioperative soft‑tissue burden and faster early recovery compared with extensile lateral plating, while maintaining similar mid‑term outcomes.