Huang HC, Che YF, Sun H, Xu YS, Gao HY, Tang XS. Traditional Chinese bone-setting combined with percutaneous screw fixation for comminuted calcaneal fractures: A case report and review of literature. World J Orthop 2025; 16(11): 111052 [DOI: 10.5312/wjo.v16.i11.111052]
Corresponding Author of This Article
Yi-Sheng Xu, PhD, Associate Chief Physician, Department of Orthopedics, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou 510120, Guangdong Province, China. xuyishengdr@gzucm.edu.cn
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Surgery
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Case Report
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 18, 2025 (publication date) through Nov 20, 2025
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World Journal of Orthopedics
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Huang HC, Che YF, Sun H, Xu YS, Gao HY, Tang XS. Traditional Chinese bone-setting combined with percutaneous screw fixation for comminuted calcaneal fractures: A case report and review of literature. World J Orthop 2025; 16(11): 111052 [DOI: 10.5312/wjo.v16.i11.111052]
World J Orthop. Nov 18, 2025; 16(11): 111052 Published online Nov 18, 2025. doi: 10.5312/wjo.v16.i11.111052
Traditional Chinese bone-setting combined with percutaneous screw fixation for comminuted calcaneal fractures: A case report and review of literature
Hui-Chun Huang, Yong-Feng Che, He Sun, Yi-Sheng Xu, Hua-Yin Gao, Xiu-Shu Tang
Hui-Chun Huang, Yong-Feng Che, Department of Orthopedics, Guangdong Provincial Hospital of Traditional Chinese Medicine, Zhuhai 519015, Guangdong Province, China
He Sun, Yi-Sheng Xu, Department of Orthopedics, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou 510120, Guangdong Province, China
Yi-Sheng Xu, Hua-Yin Gao, Xiu-Shu Tang, Department of Orthopedics, Qianxinan Autonomous Prefecture Hospital of Traditional Chinese Medicine, Xingyi 562400, Guizhou Province, China
Author contributions: Huang HC was responsible for establishing the surgical technique standards and video recording; Che YF and Sun H were responsible for medical record collection and organization; Gao HY and Tang XS were responsible for the promotion and application of the technique; Xu YS was responsible for the production of surgical videos, and the writing and submission of the manuscript.
Supported by Jin-Wen Liu Academic Experience Heritage Studio Special Fund of National Famous Traditional Chinese Medicine, No. 75.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: Xu YS reports grants from National Administration of Traditional Chinese Medicine, during the conduct of the study; grants from National Administration of Traditional Chinese Medicine, outside the submitted work.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yi-Sheng Xu, PhD, Associate Chief Physician, Department of Orthopedics, Guangdong Provincial Hospital of Traditional Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou 510120, Guangdong Province, China. xuyishengdr@gzucm.edu.cn
Received: June 23, 2025 Revised: August 15, 2025 Accepted: September 25, 2025 Published online: November 18, 2025 Processing time: 145 Days and 21.1 Hours
Abstract
BACKGROUND
Comminuted calcaneal fractures present significant treatment challenges. Open reduction and internal fixation carries risks such as infection and skin necrosis, while minimally invasive techniques may compromise reduction stability. Conservative management is generally limited to minimally displaced fractures. Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction. It offers distinct advantages including lower cost, minimal soft tissue trauma, and the avoidance of expensive reduction equipment or internal fixation materials.
CASE SUMMARY
A 60-year-old female presented with left foot pain and limited mobility following a fall. Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°. A standardized, stepwise Traditional Chinese manual bone-setting was initially performed, followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy. The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3. The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months, indicating rapid functional recovery and high patient satisfaction. At 7 months postoperatively, the American Orthopaedic Foot and Ankle Society score reached 95, prompting removal of internal fixation. At the 6-year follow-up, reduction remained well maintained, with the Böhler angle preserved at 22°.
CONCLUSION
The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.
Core Tip: This case report presents a sequential, stepwise manual reduction technique for comminuted calcaneal fractures, incorporating three standardized maneuvers, leverage, traction, and compression, prior to minimally invasive cannulated screw fixation. The Böhler angle was restored from 0° to 22°, with concurrent correction of calcaneal width. This minimally invasive technique uses small incisions, avoiding costly reduction devices or implants. At the 6-year follow-up, reduction was well maintained without loss of the Böhler angle. Thus, this approach with minimal equipment requirements provides a cost-effective surgical option, having significant potential for widespread adoption in resource-limited healthcare settings.
