When Is Social Value Proportionate to Research Risks?

Calcaneal fractures are the most common tarsal bone injury, accounting for approximately 60% of tarsal fractures and 2% of systemic fractures, mostly caused by high-energy trauma such as falls from height []. Among them, Sanders Type II-III displaced intra-articular calcaneal fractures are the most common clinical subtypes requiring surgical intervention, and the core treatment dilemma is to balance the anatomical reduction of the fracture and the protection of the soft tissue envelope around the calcaneal [, ]. Calcaneal fractures are associated with significant long-term morbidity, including chronic pain, post-traumatic arthritis, and functional impairment, which can lead to permanent disability and reduced quality of life [, ].Recent studies have shown that up to 40% of patients develop post-traumatic subtalar arthritis within 5 years of injury [, ], and approximately 15% require secondary surgery for complications []. The high burden of these complications highlights the urgent need for surgical techniques that can improve long-term outcomes while minimizing perioperative risks. Open reduction and internal fixation (ORIF) via the extensile lateral approach (ELA) has long been the mainstream treatment for this condition, which can achieve direct visualization and anatomical reduction of the fracture. However, this approach requires extensive soft tissue dissection, which damages the blood supply of the lateral calcaneal flap, resulting in a 15%-30% incidence of wound complications such as wound dehiscence, skin necrosis, and infection, which seriously affects postoperative recovery and long-term prognosis []. A large number of meta-analyses have pointed out that the high heterogeneity of baseline data such as fracture severity and soft tissue condition among previous studies makes it difficult to draw a definitive conclusion on the optimal surgical strategy for calcaneal fractures [, ].